Best Care @ Benalla Health - Feedback form

It is always our intention to provide you with the best care possible. We welcome feedback, both positive and negative, because it helps us continually improve our services for patients and their families.

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* 1. Your Details:

Date:

First Name:

Surname:

Address:

Phone Number:

Email Address:

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* 2. Are you:

Aboriginal and/or Torres Strait Islander

A member of the LGTBQA+ community

Culturally and/or linguistically diverse

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* 3. Visitor Type:

Consumer/Resident/Client/Patient

Relative/Carer

Friend

Other

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* 4. Department that feedback is for:

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* 5. Did you receive Best Care at Benalla Health? Why/Why not?

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* 6. How did that make you feel?

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* 7. What are things you feel we could do better?

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* 8. Would you recommend Benalla Health to your friends and family? Why/Why not?

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* 9. If your feedback is a concern, what outcome are you hoping for?

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* 10. Any other comments?

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* 11. Overall, how would you rate your experience at Benalla Health

Worst possible Care

Neither positive nor negative Care

Best possible Care

Worst possible Care

Neither positive nor negative Care

Best possible Care