Children's A&E Friends and Family Test (FFT) survey

English

Share your experience of children’s A&E

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 the service you received whilst in our care.

Please choose the service you visited:

1. Date of visit:

2. 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

3. Age of patient (in whole years):

Maximum value is 17

Notes

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

Yes No

Notes

5. Did you feel able to ask staff questions?

Yes No I didn’t have any questions

Notes

6. Were you involved in decisions about your care and treatment?

Yes Sometimes No I didn’t want to be involved

Notes

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

Yes Sometimes No

Notes

8. What did you think of your visit to hospital?

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

Notes

9. Please tell us what was good about your hospital visit?

4000 characters remaining

Notes

10. 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

11. Please tell us the gender of the patient?

Boy Girl Gender neutral Other Prefer not to say

Notes

12. 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

13. I self describe as:

4000 characters remaining

Notes

Share your experience of children’s A&E

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 the service you received whilst in our care.

1. Date of visit:

2. Please tell us who has completed this form

3. Age of patient (in whole years):

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

5. Did you feel able to ask staff questions?

6. Were you involved in decisions about your care and treatment?

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

8. What did you think of your visit to hospital?

9. Please tell us what was good about your hospital visit?

10. 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)?

11. Please tell us the gender of the patient?

12. What is your ethnicity?

13. 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