Patient satisfaction Survey form

Bridgewater Day Surgery is committed to providing excellent professional care in a friendly and safe environment. In order to meet our patient's total requirements, we are continually assessing and reviewing our performance.

Your feedback is vital to enable us to improve the level of service to our patients.

We value your comments and request that you complete this form and rate us on a scale of 1(Poor) to 5 (Excellent).

Please answer the following questions to indicate your level of satisfaction with our service.
At the Day Surgery reception?*
Very Unhappy A Little Unhappy Satisfied Happy Very Happy
In the pre and post operative/recovery area?*
Very Unhappy A Little Unhappy Satisfied Happy Very Happy
In operating theatre?*
Very Unhappy A Little Unhappy Satisfied Happy Very Happy
Staff Friendliness?*
Very Unhappy A Little Unhappy Satisfied Happy Very Happy
Helpfulness of staff?*
Very Unhappy A Little Unhappy Satisfied Happy Very Happy
Privacy and dignity maintained?*
Very Unhappy A Little Unhappy Satisfied Happy Very Happy
Cultural and individual values respected?*
Very Unhappy A Little Unhappy Satisfied Happy Very Happy
Conditions of facillities?*
Very Unhappy A Little Unhappy Satisfied Happy Very Happy
Post operative instructions?*
Very Unhappy A Little Unhappy Satisfied Happy Very Happy
Overall satisfaction with stay?*
Very Unhappy A Little Unhappy Satisfied Happy Very Happy
Any further comments?
Your name
Email
Day time phone number:
Mobile number
Phone
This field is for validation purposes and should be left unchanged.

Patient satisfaction Survey form

Please answer the following questions to indicate your level of satisfaction with our service.