Patient, Family & Caregiver Experience Survey

Huron Perth Healthcare Alliance: Clinton Public Hospital | Seaforth Community Hospital| Stratford General Hospital|St. Marys Memorial Hospital

Patient, Family & Caregiver Experience Survey - We Value Your Feedback

The Patient Experience Feedback process provides patients and their family members with an opportunity to express compliments or discuss questions or concerns. We encourage patients and family members to provide feedback so that we can better understand your care experience.
If you wish to speak with someone directly or have a concern regarding your visit please call the Patient Experience Office 519-272-8210 Ext. 2423 to ensure prompt action.

All responses collected are kept private and confidential.

The hospital is committed to accessibility for persons with disabilities. If you require help filling out this survey please contact the Patient Experience office for assistance.

Question Title

* 1. Date of visit

Choose the date of your visit

Date

Question Title

* 2. Type of Feedback

Compliment

Suggestion

Complaint / Concern (if you wish to have follow up please contact the Patient Experience Office directly 519-272-8210 x 2423)

Question Title

* 3. Person completing survey

Name: (Optional)