Day Surgery Patient and Family Experience Survey Question Title * 1. Who is completing this survey? Patient Family Member/Caregiver Question Title * 2. Your Day Surgery visit was to which area? Endoscopy Day Surgery Question Title * 3. Did the health professionals treating and examining you introduce themselves? Yes, all of the staff introduced themselves Some of the staff introduced themselves Very few or none of the staff introduced themselves Don't know/Can't remember Question Title * 4. Before your procedure, did a health professional explain what would happen to you, in a way you could understand? Definitely For the most part Somewhat Not at all Don't know/Can't remember I did not want an explanation Question Title * 5. Before your procedure, did your doctor or anyone from the hospital give you easy to understand instructions about getting ready for your procedure? Definitely For the most part Somewhat Not at all Don't know/Can't remember Question Title * 6. If you had to wait, were you told why? Yes No, but I would have liked a reason No, but I did not mind Don't know/Can't remember I did not have to wait Question Title * 7. If you had any worries or fears about your condition or treatment, did a surgeon talk with you about them? Definitely For the most part Somewhat Not at all I did not have worries or fears Question Title * 8. If you had questions to ask the anaesthesiologist, did you get answers that you could understand? Definitely For the most part Somewhat Not at all I did not need to ask I did not have an opportunity to ask Question Title * 9. How much information about your condition or treatment was given to your family, caregiver or someone close to you? Not enough Right amount Too much No family, caregiver or friends were involved They didn't want or need information I didn't want them to have any information Don't know/Can't say Question Title * 10. How often, during your most recent day surgery experience, were you involved as much as you wanted to be in decisions about your care and treatment? Always Usually Sometimes Never Question Title * 11. Before you left the hospital, were you told what would happen next (for example, did you need another appointment, did you need to see your family doctor)? Definitely For the most part Somewhat Not at all Don't know/can't remember Question Title * 12. Did you receive information about what symptoms or health problems regarding your illness or procedure to watch for at home? Definitely For the most part Somewhat Not at all I did not need this type of information Question Title * 13. Did you receive enough information from hospital staff about what to do if you were worried about your condition or treatment after you left the hospital? Definitely For the most part Somewhat Not at all Question Title * 14. Overall, did you feel you were treated with respect and dignity while you were at the hospital? Definitely For the most part Somewhat Not at all Question Title * 15. Thinking about your experience related to this day surgery visit, to what extent did you experience smooth transitions between the hospital and other locations or health professionals? Always Usually Sometimes Never Not applicable Question Title * 16. Overall...(Please pick a number) 0 I had a very poor experience 1 2 3 4 5 6 7 8 9 10 I had a very good experience Question Title * 17. What else would you like to share about your visit to Day Surgery? Question Title * 18. Is there a staff member or group that you would like to recognize for providing exceptional care or service? If you have any immediate questions or concerns regarding your experience with us, please contact our Patient Relations Office using the contact information below. Done