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Patient Questionnaire

On discharge from the Hospital you will receive a patient questionnaire, we encourage you to complete and return this form.

If for any reason you have not received this form, you can complete the online feedback survey below or print a copy of the PDF and return it to us.

Download > Open a pdf (63kb)

 

Thank you for choosing to come to Wakefield Hospital.

We are committed to providing a high quality service and value your feedback to assist us to monitor and improve our standards. While compliments are gratefully accepted, suggestions for improvements are also welcome.

Please take a few minutes to complete this questionnaire.

General Information


Reception/Administration

  • Excellent
  • Very Good
  • Good
  • Fair
  • Needs Improvment

Would you like to add any comments regarding Reception/Administration?

Yes No


Nursing – Wards / Short Stay Ward

  • Excellent
  • Very Good
  • Good
  • Fair
  • Needs Improvment

Would you like to add any comments regarding Nursing – Wards / Short Stay Ward?

Yes No


Nursing – Intensive Care Unit / High Dependency Unit (if relevant)

  • Excellent
  • Very Good
  • Good
  • Fair
  • Needs Improvment

Would you like to add any comments regarding Nursing – Intensive Care Unit / High Dependency Unit?

Yes No


Nursing – Theatre and Recovery

  • Excellent
  • Very Good
  • Good
  • Fair
  • Needs Improvment

Would you like to add any comments regarding Nursing – Theatre and Recovery?

Yes No


Medical Staff (Doctors)

  • Excellent
  • Very Good
  • Good
  • Fair
  • Needs Improvment

Would you like to add any comments regarding Medical Staff (Doctors)?

Yes No


Housekeeping

  • Excellent
  • Very Good
  • Good
  • Fair
  • Needs Improvment

Would you like to add any comments regarding Housekeeping?

Yes No


Facilities

  • Excellent
  • Very Good
  • Good
  • Fair
  • Needs Improvment

Would you like to add any comments regarding Facilities?

Yes No


Food Service

  • Excellent
  • Very Good
  • Good
  • Fair
  • Needs Improvment

Would you like to add any comments regarding Food Service?

Yes No


Ancillary Services e.g. Outpatient Clinics, Physiotherapy

  • Excellent
  • Very Good
  • Good
  • Fair
  • Needs Improvment

Would you like to add any comments regarding Ancillary Services?

Yes No


Patient Code of Rights

Did you feel that the staff promoted the Health & Disability Commissioner's "Code of Health & Disability Services Consumers' Rights" to you and your family?

  • Yes
  • No

Would you like to add any comments regarding Patient Code of Rights?

Yes No


Your overall experience

  • Excellent
  • Very Good
  • Good
  • Fair
  • Needs Improvment

Would you like to add any comments regarding your overall experience?

Yes No


Special Comments

 
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