Feedback Survey

Feedback Survey

Fields marked with an * are required

I was a patient on the unit ...*

Select

Q1*

Overall, how would you rate the care and service you received at our hospital?

Poor

Fair

Good

Very Good

Excellent

N/A

Q2*

During this hospital visit, did the hospital staff explain things in a way you could understand?

Not at all

Partly

Quite a bit

Completely

N/A

Q3*

During this hospital visit, did the hospital staff treat you with compassion and respect?

Never

Sometimes

Usually

Always

N/A

Q4*

During this hospital visit, did the hospital staff introduce themselves?

Never

Sometimes

Usually

Always

N/A

Q5*

Regarding discharge, have hospital staff ensured you are aware of what will happen next with your care?

Not at all

Partly

Quite a bit

Completely

N/A

Q6*

During this hospital visit, how satisfied were you with the cleanliness of the hospital?

Not at all

Partly

Quite a bit

Completely

N/A

Q7*

During this hospital visit, were you and your family involved as much as you wanted to be regarding decisions about your care and treatment?

Never

Sometimes

Usually

Always

N/A

Q8*

Did you experience racism and/or discrimination while receiving care at the hospital based on your citizenship, race, place of origin, ethnic origin, colour, ancestry, disability, age, creed, sex/pregnancy, family status, marital status, sexual orientation, gender identity, and/or gender expression?

Yes

Prefer not to answer

If yes to the above, please describe below

Q9*

I am a...

Patient

Caregiver

Tell us one thing we did well and one thing we can do to improve.

Would you like to contact Patient Experience for further follow-up

Yes I would

Patient Experience Contact

Floriana Sherifi, Patient Experience Specialist

Email: patientexperience@stegh.on.ca

Telephone: 519-631-2030 ext. 2184

(If you get our voicemail, please leave a brief message and your call will be returned)

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