Outpatient Services Feedback

We would like you to think about your recent visit to the hospital. By answering these questions, you will help us to understand your experience and therefore assess and improve the quality of care we give and the future experience of patients/service users.

Please select the hospital your appointment was carried out at *

Please select the date of your visit *

Thinking about your recent visit, how was your experience of our service? *

Very Good
Good
Neither Good nor Poor
Poor
Very Poor
Don't Know

Please tell us why you gave this answer

Please tell us what we could do differently or better

Are you the patient, carer, friend or family member? *

We may use your comments as part of Trust publications and reports. Any comments used will be kept anonymous. Please indicate below if you would like your comments to be used in this way: *

Thanks for filling out the feedback form.

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