Elective admission and waiting list communication survey
Thank you for visiting our hospital. If you could spare a few minutes, please complete this survey so that we can improve our elective admission processes and our waiting list communications. If you have any questions about the form, then please contact us at 04** *** ***
Where did you receive information about our elective admission processes (e.g. what to bring to your surgery)?
*
Via our website
Via a hospital visit prior to your surgery (e.g. during a pre-admission appointment)
Via phone call
Via our 'Confirmation of Appointment' letter
None of the above
On our website, how satisfied were you with:
*
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
The content of the information?
The presentation of the information?
When visiting the hospital, how satisfied were you with:
*
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
The content of the information?
The delivery of the information?
In our phone call(s), how satisfied were you with:
*
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
The content of the information?
The delivery of the information?
In our letter, how satisfied were you with:
*
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
The content of the information?
The presentation of the information?
Back
Next
Did you attend a pre-admission appointment?
*
Yes
No
During your pre-admission appointment, how satisfied were you with:
*
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
The attitudes of our staff?
The helpfulness of our staff?
The hygiene of our facility?
The wait time for your appointment?
Back
Next
On the day of your surgery, how satisfied were you with:
*
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
The attitudes of our staff?
The helpfulness of our staff?
The hygiene of our facility?
The wait time for your surgery?
The information received (including any explanations provided)?
Was there anything in particular that you liked or disliked about our elective admission processes (excluding waiting list communication)? Please elaborate
Back
Next
How did our hospital communicate your waiting list status to you (including any updates to it)?
*
Via phone call
Via letter
Via SMS
None of the above
During our phone call(s), how satisfied were you with:
*
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
The content of the information?
The delivery of the information?
During our letter(s), how satisfied were you with:
*
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
The content of the information?
The presentation of the information?
During our SMS(s), how satisfied were you with:
*
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
The content of the information?
The delivery of the information?
Were you informed about:
*
Yes
No
Can't Remember
Your category of surgery (urgent, semi-urgent or non-urgent)?
The expected wait time for your surgery?
How satisfied were you with:
*
Very Unsatisfied
Unsatisfied
Neutral
Satisfied
Very Satisfied
The frequency of our wait list communications?
Was there anything in particular that you liked or disliked waiting list communications? Please elaborate
Back
Next
Thank you for completing this survey. As part of our commitment to continuous quality improvement, we publish the results of this survey in our end of year report. If you have any questions or concerns about this, then please call us at 04** *** ***.
For participants who have completed this form physically, please post it to: Elective Survey, PO Box ****, Athy VIC 0001
For participants who have trialed this survey, please provide your feedback below (try to include both positives and negatives if you can)
*
Submit
Should be Empty: