*Stoma service patient experience questionnaire (PE359)

We want to provide the best experience possible for patients, your feedback will help us to improve the service we provide. All responses are anonymous. Thinking about your recent appointment…………………..

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* 1. Overall, how was your experience of the Stoma service?

Very good

Good

Neither good nor poor

Poor

Very poor

I don't know

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* 2. Please tell us why you gave your answer

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* 3. Please tell us which clinic you have visited today

Frome

Trowbridge

Keynsham

Chippenham

Bath

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* 4. Did staff listen to you and act on what you told them?

Yes, definitely

Yes, to some extent

No, not really

No, not at all

N/A

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* 5. Did staff treat you with compassion?

Yes, definitely

Yes, to some extent

No, not really

No, not at all

N/A

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* 6. Please tell us how the Stoma clinic being held in the community is beneficial to you

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* 7. Please tell us what we do well

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* 8. Please tell us what we could improve

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* 9. Do you consent to your anonymous responses being shared/made public?

Yes

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* 10. Today's date

Date / Time

Date