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Inpatient survey

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 ward where you spent most of your time.


1. Date

2. Thinking about the service we provide, overall, how was your experience of our service?

3. Can you tell us why you gave that response?

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4. Was your admission planned in advance or an emergency?

5. Do you regard yourself as having a disability, impairment, or other condition that requires extra support or reasonable adjustments?

6. If yes, did the hospital staff do everything they could to provide this support or adjustments?

7. Do you think the hospital staff did everything they could to help control your pain?

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

9. Other than doctors and nurses, did you have confidence and trust in any other clinical staff treating you (e.g. physiotherapists, speech therapists, pain team, dietitians)?

10. Did you find someone on the hospital staff to talk to about your worries and fears?

11. Did you feel you were involved in decisions about your discharge from hospital?

12. Did you feel that your privacy and dignity were considered while you were in hospital?

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

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

14. Are you

15. Age

16. What is your ethnicity?

17. If you answered 'self-describe' to the previous question, please specify:

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Thank you

Thank you for taking the time to complete this survey