Consumer feedback form

Patient Details

Your Feedback

My individual needs were met

 Strongly Agree     Agree    Neither agree or disagree    Disagree     Strongly disagree  

I felt cared for

 Strongly Agree     Agree    Neither agree or disagree    Disagree     Strongly disagree  

I felt safe

 Strongly Agree     Agree    Neither agree or disagree    Disagree     Strongly disagree  

Staff Satisfaction

Reception

 Excellent     Satisfactory    Average    Could Improve  

Admission

 Excellent     Satisfactory    Average    Could Improve  

Nursing staff

 Excellent     Satisfactory    Average    Could Improve  

Recovery

 Excellent     Satisfactory    Average    Could Improve  

Discharge

 Excellent     Satisfactory    Average    Could Improve  

Please add any comment below

Interpreter

Do you require an interpreter?

 Yes     No  

If so, which language?