This questionnaire will help to look into the levels of service you received in health care. Please take the time to give your honest opinion on each of the questions, as this will help us to drive an improvement in service. All your answers will be kept in the strictest of confidentiality. If you have any questions about this survey, please contact [NAME] on [TELEPHONE] or [EMAIL].
Thank you in advance for the help you are giving us.
1. Which local authority do you live in?
2. If there are several hospitals in your area, are there differences in services?
3. Do you have a preference for which hospital you go to?
4. Do you usually go to the same hospital?
5. Are you able to judge the difference between the various hospitals?
6. Could you help your friends in choosing the best hospital for them?
7. Does your family pressure you to have any medical needs seen to straight away?
8. Please rate the following statements.
9. The hospital has all necessary equipment for treatment and diagnosis.
10. The Hospital has Modern Operating Rooms.
11. What kind of medical insurance do you currently hold?
12. How often have you or a member of your family visited the doctor in the past 12 months?
13. How often have you visited someone in hospital in the past 12 months?
14. If you had a personal injury that could be treated at any clinic, which clinic would you prefer?
15. If you received medical care at a hospital outside of your area, why did you do so?
16. Who makes decisions about health care in your family?
17. Who decides which hospital should be used?
18. What treatment have you heard people receive at the hospital you have gone to?
The following questions help us to monitor the demographics of our respondents. We need these to ensure we can offer the best service to people in all age, gender and race sections of the population. Naturally, these results will be fully confidential.
21. Age or Ages of Child(ren) in Your Household (please tick all that apply)
22. What is Your Marital Status?
23. What is your total annual household income before tax?
24. Please indicate your highest level of completed schooling:
25. What is Your Occupation?