Children's day surgery Friends and Family Test (FFT) Survey

English

Share your experience of children’s day surgery

Your feedback helps us to celebrate what’s working well and identify where we need to improve. We would be grateful if you would take a moment to review your experience of our day surgery unit.

1. Please tell us who has completed this form

The child who went to hospital The parent or carer of the child who went to hospital Both child and parent/carer together

Notes

2. Age of patient (in whole years):

Notes

3. Were there enough things for you to do in the hospital?

Yes No

Notes

4. Did you feel able to ask staff questions?

Yes No I didn’t have any questions

Notes

5. Were you given enough privacy when you were receiving care and treatment?

Yes Sometimes No

Notes

6. Would you want your friends or family to come here if they needed the same help as you?

Very good Good Neither good nor poor Poor Very poor I don't know

Notes

7. Please tell us what was good about your hospital stay?

4000 characters remaining

Notes

8. Please tell us what we could do better?

4000 characters remaining

Can we share your comment publicly (for example, on our website or printed material such as posters)?

Yes No

Notes

9. Please tell us the gender of the patient?

Boy Girl Gender neutral Other Prefer not to say

Notes

10. What is your ethnicity?

Asian / Asian British Black / African / Caribbean / Black British Mixed / Multiple ethnic groups White / White British Self-describe - please specify below Prefer not to say

Notes

11. I self describe as:

4000 characters remaining

Notes

Share your experience of children’s day surgery

Your feedback helps us to celebrate what’s working well and identify where we need to improve. We would be grateful if you would take a moment to review your experience of our day surgery unit.

1. Please tell us who has completed this form

2. Age of patient (in whole years):

3. Were there enough things for you to do in the hospital?

4. Did you feel able to ask staff questions?

5. Were you given enough privacy when you were receiving care and treatment?

6. Would you want your friends or family to come here if they needed the same help as you?

7. Please tell us what was good about your hospital stay?

8. Please tell us what we could do better?

Can we share your comment publicly (for example, on our website or printed material such as posters)?

9. Please tell us the gender of the patient?

10. What is your ethnicity?

11. I self describe as:

Submit

Thank you for taking the time to share your feedback.

©2020 University Hospital Southampton NHS Foundation Trust. All rights reserved. Not to be reproduced in whole or in part without the permission of the copyright holder. Published November 2020