Feedback Form

Today's Date

Date

Clinical Trial you were involved in at PARC

Example: Please include either description of the study or the protocol number from the information sheet

Did your nurse/medical staff members introduce themselves to you?

Did you feel confident to ask questions?

When you rang your patient bell, or asked for help, did a staff member respond in a reasonable time frame?

How was the noise level during your visits?

Please provide your feedback on the quality of our service over the course of your study visits.

Do you have any other feedback about your visits at PARC? What did we do well? What can we improve on?

If you'd like to receive any updates on how your feedback has been implemented, please provide your email address:

example@example.com

Would you like your details to remain on our database at PARC to be contacted for any future trials? Your information remains confidential.

YesNo

If Yes, please provide your Participant Study ID Number

This is the number given to you at the start of the study, example: 100-010

Thank you for taking time to complete this feedback.

We are always striving to provide the best quality of patient care.

Privacy: We often need to gather and keep sensitive and private information about you. Everyone who works for CALHN must keep your information private under federal law. Staff and volunteers must follow SA Health's privacy guidelines available at www.health.sa.gov.au. Your feedback will not become part of your medical records.

For more information: Should you wisjh to escalate any immediate concerns please ask to speak with the PARC Unit Nurse Manager. For any other feedback or questions, please contact our consumer experience team. A team member can meet with you Monday to Friday between 9am and 4pm.
Phone: (08) 7074 1377 Email: HealthCALHNConsumerExperience@sa.gov.au

End of Study Feedback