Patient Feedback Questionnaire

Please Select N/A Orthopaedic Neurosurgery General Surgery Obstetrics & Gynaecology ENT Cardiology Paediatrics Paediatric Surgery

	Yes definitely	Yes to some extent	Not really	Definitely not	Does Not Apply
Was the clinician/medical health practitioner polite and considerate?
Did the clinician/medical health practitioner listen to what you had to say?
Did the clinician/medical health practitioner give you enough opportunity to ask questions?
Did the clinician/medical health practitioner answer all your questions?
Did the clinician/medical health practitioner explain things in a way you could understand?
Are you involved as much as you want to be in the decisions about your care and treatment?
Did you have confidence in the clinician/medical health practitioner?
Did the clinician/medical health practitioner respect your views?
If the clinician/medical practitioner examined you, did he or she: a. Ask your permission? b. Respect your privacy and dignity?
By the end of the consultation did you feel better able to understand and/or manage your condition and your care

	Not Satisfied	Somewhat Satisfied	Satisfied	Does Not Apply?
Service Quality
Cleanliness
Responsiveness
Friendliness
Nurses' conduct
Medical Officers conduct'
Consultant's conduct
Nurses' treatment
Medical Officers treatment
Consultants treatment

	Yes definitely	Yes to some extent	Not Really	Definitely not	Does Not Apply
Were you satisfied with the treatment provided?
Were you involved as much as you wanted to be in the decisions about your care and treatment?
Did the clinician/medical health practitioner explain things in a way you could understand?
Did the clinician/medical health practitioner give you enough opportunity to ask questions?
Was the clinician/medical health practitioner polite and considerate?
Did the clinician/medical health practitioner listen to what you had to say?

Please Select Very satisfied Fairly satisfied Not really satisfied Not at all satisfied