We would like to know how you feel about the services we provided, so we can make sure we have met your expectations. Your responses are directly responsible for improving these services. All responses will be kept confidential.
Thank you for your time.

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1. Name

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2. Patient Reference Number (Optional)

The Hospital Reference Number (UR) is found above you name on all paperwork you will have received

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3. Date of Surgery/procedure/ Consultation (dd/mm/yyyy)

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4. Location of Surgery/ Procedure/Consultation

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5. Hospital Experience

  Exceeded Expectations Met Expectations Did not meet Expectations
Booking Process was:
Nursing Pre Procedure Call/ Appointment was:
Reception Admission Process was:
Education Forms/ Brochures were:
Nursing Admission Process was:
Doctors Communication:
Nursing Discharge process:
Overall Discharge Process was:
Explanation of Costs:
Staff and Doctors were:
The Overall Atmosphere was:
The encouragement to ask Questions:
The Overall Experience :
Would you like further information on the services we offer (PTO) and complete name below?

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6. Did you Develop a Wound Infection Post Surgery?

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7. Did you Experience Uncontrolled Pain?

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8. If Yes, Did you Report this?

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9. Were you Admitted to an Acute Care Hospital?

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10. Was there any Particular Member of Staff you would like to Thank

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11. Would you like Information on other Montserrat Services, Such as Gynaecology, Pain Management , etc...

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12. If Yes, What would you like more Information on?

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13. Would you like us to Contact you about any Aspect of this Survey or your Experience?

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14. If Yes, Please enter your best contact number

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15. Would you Recommend Us?

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16. Comments/ Suggestions

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