Surgical Services Feedback Survey Question Title * 1. How often did care providers treat you with courtesy and respect? Never Sometimes Usually Always Question Title * 2. How often did care providers explain things in a way you could understand? Never Sometimes Usually Always Question Title * 3. Did you feel that there was good communication about your care between doctors, nurses and other hospital staff? Never Sometimes Usually Always Don’t know/Not sure Question Title * 4. Did you get the emotional support you needed to help you with any anxieties, fears or worries you had during this hospital visit? Never Sometimes Usually Always Not Applicable Question Title * 5. Did care providers do everything they could to ease your discomfort or symptoms? No Yes, somewhat Yes, mostly Yes Not applicable Question Title * 6. Did you receive enough information from hospital staff about what to do if you were worried about your condition or treatment after you left the hospital? Not at all Partly Quite a bit Completely Question Title * 7. Overall… (Please circle a number) 0 - I had a very poor experience 1 2 3 4 5 6 7 8 9 10 – I had a very good experience Question Title * 8. Were there any barriers (physical, language, accessibility) that made it difficult to access services? (Comment if there were barriers) Question Title * 9. What else would you like to say about your surgical services experience? Done
