PSQS Outpatient Experience Evaluation

Please help us improve the quality of care we provide to patients and families by telling us about your experience today.

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* 1. This survey is completed by?

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* 2. Which specialty did you attend today?

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* 3. Please enter the postcode of where you live

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* 4. Which language or languages do you speak at home?

English

Asian (please specify below)

Middle Eastern (please specify below)

African (please specify below)

Other (please specify below)

Please provide details

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* 5. Did you receive all the information you needed before attending this appointment?

Yes, I had all the information required

No.

Please tell us what information would have helped:

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* 6. Please answer the following questions to rate your experience today

	Always	Usually	Sometimes	Never
Did you feel you and your child were treated with courtesy, dignity and respect?	Did you feel you and your child were treated with courtesy, dignity and respect? Always	Did you feel you and your child were treated with courtesy, dignity and respect? Usually	Did you feel you and your child were treated with courtesy, dignity and respect? Sometimes	Did you feel you and your child were treated with courtesy, dignity and respect? Never
Were you involved in decisions about your child's care and treatment?	Were you involved in decisions about your child's care and treatment? Always	Were you involved in decisions about your child's care and treatment? Usually	Were you involved in decisions about your child's care and treatment? Sometimes	Were you involved in decisions about your child's care and treatment? Never
When you asked questions about your child's condition, did you receive answers that you could understand ?	When you asked questions about your child's condition, did you receive answers that you could understand ? Always	When you asked questions about your child's condition, did you receive answers that you could understand ? Usually	When you asked questions about your child's condition, did you receive answers that you could understand ? Sometimes	When you asked questions about your child's condition, did you receive answers that you could understand ? Never

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* 7. Overall, how would you rate the level of teamwork amongst the staff that provided care to your child?

Excellent

Good

Fair

Poor

Excellent

Good

Fair

Poor

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* 8. How would you rate your child's overall outpatient experience?

Excellent

Good

Fair

Poor

Excellent

Good

Fair

Poor

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* 9. Do you feel your child received high quality safe care?

Yes

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* 10. If there was a delay greater than 60 minutes with your appointments or procedures, was this explained and were time-frames provided?

Yes

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* 11. Is there a member of staff you would like to thank?

Yes

If yes, please provide details:

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* 12. What else would you like to tell us about?

Thank you for taking the time to complete this survey.

If you would like to tell us more about your experience please
Email: CHQ_PatientExperience@health.qld.gov.au
Or you can speak with our patient experience team by calling (07) 30681120

Please do not provide any personal information on this form as your feedback will be collated into Survey Monkey – an
electronic online system.