Acute Home Visiting Service Feedback

1. Acute Home Visiting Service

Feedback Questionnaire

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1. How satisfied are you with your recent visit from the Acute Home Visiting Service?

1 - Not satisfied
2 - Neither not satisfied or satisfied
3- Very satisfied

2. How prepared was the clinician for your visit?

1 - Not prepared
2 - Somewhat prepared
3- Very prepared

3. Did the clinician explain your condition, medications, instructions and follow up care clearly?

1 - Not clearly
2 - Parts were clear and parts were missing
3- Very clearly

4. Did you get all the answers to your questions from the clinician during or after the consultation?

1 - None of my questions were answered
2 - Some of my questions were answered
3- All of my questions were answered

5. Do you feel that the visit was conducted in a timely manner?

1 - Not timely
2 - Very timely

6. How would you rate the professionalism and politeness of our clinical staff?

1 - Not professional
2 - Very professional

7. Please provide the name of the visiting clinician and any comments or additional feedback for the Acute Home Visiting Service.

8. Which practice are you registered with?

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