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Cranford Hospice Service Feedback Form
We value your input into our service delivery and we like to find out how well Cranford Hospice and its staff are meeting the personal needs of our patients, their family and whānau.
1.
Two things that you found really good:
2.
Two things we could improve on:
3.
What area in Hawke's Bay are you based in?
North (Napier, Taradale)
South (Hastings, Havelock North)
Central Hawke's Bay
Wairoa District
Other (please specify)
4.
What is your relationship with Cranford Hospice?
Patient
Family or whānau
Carer
Healthcare provider
Other (please specify)
5.
What services have you had access to? Tick all that apply.
Inpatient Unit
Community / Home visits
Family Support Team: Counsellor, Social Worker, Occupational Therapy, Carer Support, Pastoral Care, Music Therapist
Kaitakawaenga
Other (please specify)
6.
From a scale of 1-10 please rate your experience with us on the following:
Extremely Poor
Average
Excellent
N/A
The care and support we provide
Extremely Poor
Average
Excellent
N/A
The frequency of contact with you
Extremely Poor
Average
Excellent
N/A
The clarity of information and advice we provide
Extremely Poor
Average
Excellent
N/A
The support and advice we provide to family and whānau
Extremely Poor
Average
Excellent
N/A
The respect we show for your cultural, religious and spiritual needs
Extremely Poor
Average
Excellent
N/A
Please share any comments.
7.
Please feel free to share your name and contact details so we can thank you for completing this survey.
Name
Address
City/Town
Postal Code
Email Address
Phone Number
8.
Would you like us to contact you to discuss any feedback you have in more detail?
Yes
No
9.
Any other comments:
