Medicana Feedback Form

Feedback Form

To help us measure our level of achievement we would be grateful if you could take a few moments to complete this questionnaire. We regard your opinions and comments as extremely valuable and we use them to identify areas of success and opportunities for improvement.
Name (optional)

First NameLast Name
Which hospital did you attend?*

Winchester
Please select the relevant department.*

RadiologyTheatreOutpatientsAdministration/ Bookings TeamMinor OpsOther
Are you an NHS or Private patient? (self funded, private health insurance)*

NHSPrivate
Thinking about your recent experience with us, overall, how was your experience of our service?*

Very GoodGoodPoorVery PoorUnsure
Quality of care
Did you receive enough information before your visit?*

Yes, DefinitelyYes, to some extentNoN/A
How would you rate the waiting room facilities?*

ExcellentVery GoodGoodFairPoorN/A
How would you rate the cleanliness of the department?*

ExcellentVery GoodGoodFairPoorN/A
How close to your appointment time were you seen?*

On TimeEarlyLateN/A
How were you greeted by the reception team when you arrived?*
How was your experience with the Administration/ Bookings team? Do you feel that you received the required information? *
Did the staff involved in your care introduce themselves to you?*

Yes, AlwaysYes, SometimesNoN/A
Were you treated with care and compassion?*

Yes, AlwaysYes, SometimesNoN/A
Were you given enough privacy when discussing your condition or treatment?*

Yes, AlwaysYes, SometimesNoN/A
Did we explain what would be done before providing you any care or treatment?*

Yes, AlwaysYes, SometimesNoN/A
Did you have confidence and trust in the staff caring for you?*

Yes, DefinitelyYes, SometimesNoN/A
Were you provided with all the information you needed in a way you could understand?*

Yes, DefinitelyYes, SometimesNoN/A
Were you involved as much as you wanted to be in decisions about your care and treatment?*

Yes, DefinitelyYes, SometimesNoN/A
How well did we resolve any concerns you had whilst in our care?*

Very wellFairly wellNot very wellStill not resolvedN/A
Would you be happy to return for future appointments?*

YesNo
Please give your opinion of the clear explanation of any costs associated with your treatment and care?*

ExcellentVery GoodFairPoorN/A
Do you have any further comments or suggestion you would like to share?*
Would you like to mention any members of staff by name who stood out to you? Please tell us what made them special. *
On occasion we like to anonymously publish our respondents comments as examples of successes or where we have used feedback to make improvements to our services. Please indicate here if you are happy for us to publish any comments you have made, this will not be identifiable to you.*

I am happyI am not happy
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Feedback Form

Quality of care