Poole Hospital NHS Foundation Trust: Feedback form

Poole Hospital NHS Foundation Trust, Longfleet Road, Poole, Dorset BH15 2JB. Tel: 01202 665511

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Does your feedback relate to your experience as an:*	Inpatient Outpatient Emergency department patient Other
What did your hospital visit relate to (eg fracture, cardiac condition, physiotherapy etc)?
Which department(s) or ward(s) did you visit or stay in?
Were you satisfied with how clean the hospital environment was?	Yes No
Did you feel you received enough information while you were in hospital?	Yes No
Did you feel you were involved as much as you wanted to be in decisions about your care and treatment?	Yes No
Did you feel you were treated with respect and dignity while you were in hospital?	Yes No
Overall, how would you rate the care you received?	Excellent Very good Good Poor Very poor
Do you have any further comments about your care?
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