Name
Ward/Department
Room/Bed No
Patient or Visitor
Contact No or Email Address
Would you like the opportunity to discuss this feedback?
Yes
No
Please indicate your level of agreement with the following statements:
1. The hospital’s admission process was efficient and well-organized.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
2. The medical staff provided high-quality care during my stay.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
3. I felt involved in decisions about my care and treatment.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
4. Nursing staff were responsive to my needs and requests.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
5. I was satisfied with the care and support provided by the Allied Health team.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
6. I was treated with dignity, kindness, and respect by all hospital staff.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
7. My room was clean and comfortable
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
8. The quality of the food and meal ordering process met my needs.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
9. I received clear instructions regarding my discharge and follow-up care.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
10. Overall, I am satisfied with my experience and would recommend the hospital to others.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Additional Comments:
What did we do well?
What can we improve?
Is there anything else you would like us to know ?