Children, young people survey - outpatients Friends and Family Test (FFT) survey

English

Children, young people outpatient survey

Please choose the service you visited:

1. Please tell us who is completing this form

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

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2. Age of patient (in whole years)

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

Yes No

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4. Did you feel able to ask staff questions?

Yes No I didn't have any questions

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

Yes Sometimes No I didn't want to be involved

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

Yes Sometimes No

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7. What did you think of your visit to hospital? Please tick one box only

Very good Good Neither good nor poor Poor Very poor Don't know

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

4000 characters remaining

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9. Please tell us what we could do better?

4000 characters remaining

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

Yes No

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10. Is there a member of staff you would like to recommend and what did they do to impress you?

4000 characters remaining

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11. Please tell us the gender of the patient?

Boy Girl Gender neutral Other Prefer not to say

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12. What is your ethnicity?

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

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13. If you answered 'self-describe', please specify:

4000 characters remaining

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Thank you for taking the time to share your feedback.

©2021 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 January 2021