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Glenelg Community Hospital Day Patient Feedback Survey v2
We thank you for providing us with feedback about your time at Glenelg Community Hospital. Your feedback will be used to help us continuously improve our services.
*
1.
Admission Date
(Required.)
Date
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
*
2.
Were you a:
(Required.)
Self Insured Patient
Private Heath Insured Patient
SA Health Patient
*
3.
Was the Hospital online admission & health questionnaire easy to complete?
(Required.)
Yes
Somewhat
No
Comment
*
4.
Was your admission process on the day a positive experience?
(Required.)
Yes
Somewhat
No
Comment
*
5.
Were the staff polite, professional, respectful, considerate and listened well?:
(Required.)
Extremely
Quite
Moderately
Slightly
Not at all
Comment
*
6.
Were you happy with the quality of care you received?
(Required.)
Extremely
Quite
Moderately
Slightly
Not at all
Comment
*
7.
Was your environment clean and comfortable?
(Required.)
Yes
Somewhat
No
Comment
8.
Did you view staff practicing Hand Hygiene?
Yes
No
Comment
Post-Operative & Discharge Questions
*
9.
Did you receive adequate information and instructions regarding discharge?
(Required.)
Yes
No
Comment
*
10.
Has your post-operative pain been well controlled?
(Required.)
Yes
No
N/A
Comment
*
11.
Have you experienced any unexpected bleeding since discharge?
(Required.)
Yes (if yes, please contact your admitting doctor/surgeon)
No
N/A
Comment
*
12.
Did the nurses and doctors explain things in a way you could understand?
(Required.)
Extremely well
Quite well
Moderately well
Slightly well
Not at all well
Comment
13.
On discharge were you provided with information on site infection or antibiotics?
Yes
No
N/A
Comment
14.
How likely are you to choose this hospital for your care in the future?
Extremely likely
Quite likely
Moderately likely
Slightly likely
Not at all likely
Comment
*
15.
We would value your contribution in one of our focus groups we hold throughout the year, would you like to participate?
(Required.)
Yes
No
If yes, please advise your Name, Contact Number & Admitting Doctor
16.
Do you have any suggestions for improvements or feedback?
17.
If you would like us to contact you regarding your responses, please advise your Name, Contact Number & Admitting Doctor:
We appreciate your feedback.
If you have any medical concerns or feel uncertain about your recovery following your procedure, please contact your Admitting Doctor. In the event of an emergency, present to your nearest Emergency Department.