TURP Video Patient Feedback Form

 

1. How old are you?

 

2. Are you able to use the following devices? (check all that apply)

 

3. Were you shown a video as part of the consenting process?

 

4. What procedure did you have done?

 

5. How was this done?

 

6. Why did we undertake this procedure?

 

7. What are the main risks involved with the procedure?

 

8. On a scale from 1 to 5, please answer the following questions

Extremely effectiveVery effectiveModerately effectiveSlightly effectiveNot at all effective
How well did the video explain how the procedure is performed?
How well did the video explain why it is performed?
How well did the video explain the risks and benefits of the procedure?
How well did the video explain alternatives to the procedure?
How well did the video explain the recovery process after the procedure?
 

9. How satisfied were you with the consenting process?

 

10. Are there any improvements you would recommend to the pre-operative consenting process?

 

11. Do you have any additional comments?

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