SynergyHP Patient Feedback Form Patient experience is an important component of measuring quality in healthcare. We are proud of our service and want to ensure your time with us exceeds your expectations. In addition, we are always looking for ways to improve our service and we value your views. We appreciate your time in completing this form about your recent hospital experience under our care.General QuestionsSynergyHP Number(Required)(If unknown, please type “unknown”)The name of the hospital you were treated at?(Required)Date of visit(Required) Day Month Year Type of treatment(e.g. dermatology surgery)Overall, how would you rate your treatment- excellent, good, poor, very poor?(Required) Excellent Good Poor Very poor Overall, any suggestion of how the process could be improved?(Required)Specific QuestionsWere you informed of the process prior to your appointment?(Required) Yes Yes to some extent No Were you made to feel welcome?(Required) Yes Yes to some extent No Were you seen on time?(Required) Yes Yes to some extent No If late, were you kept informed of delays?(Required) Yes Yes to some extent No Did the staff introduce themselves?(Required) Yes Yes to some extent No Did you have confidence in the nurses caring for you?(Required) Yes Yes to some extent No Did you have confidence in the doctors treating you?(Required) Yes Yes to some extent No Were you fully involved in the decision making about your treatment?(Required) Yes Yes to some extent No If you had any questions were they answered in a way you could understand?(Required) Yes Yes to some extent No Were you given clear information post consultation/treatment?(Required) Yes Yes to some extent No (e.g. what to expect, what happens next?)Were you given information regarding who to contact if problems afterwards?(Required) Yes Yes to some extent No Did you feel you were treated with respect and dignity?(Required) Yes Yes to some extent No
