‌

SWB Audiology Patient Experience Questionnaire (QR code)

Page 1

Your feedback is important to us! Please take a few moments to complete this questionnaire about your recent experience of our Audiology service. All questions marked with an * require a response.

If you have a complaint/ suggestion you wish to discuss further with us, please email: swb-tr.audiology@nhs.net and enter Audiology Patient Group in the subject box.
*
Question 1.

Are you completing this questionnaire for :

- Required.
*
Question 2.

Was your appointment via:

- Required.
This is required
*
Question 3.

If your appointment was face-to face, at which location were you seen?

- Required.
*
Question 4.

What type of appointment did you attend?

- Required.
This is required
*
Question 5.

How satisfied were you with the choice of appointment date, time and location (if applicable)?

- Required.
*
Question 6.

Were you made to feel welcome? This can include telephone conversations and email correspondence.

- Required.
This is required
*
Question 7.

How satisfied were you with the way the clinician communicated with you at your appointment including the explanation of any test results and the options available to you?

- Required.
*
Question 8.

How satisfied were you with any written information you received, including appointment letters?

- Required.
This is required
*
Question 9.

How likely are you to recommend this centre/ service to your friends and family if they needed similar care or treatment?

- Required.
This is required
Question 10.

Do you have any suggestions you would like to make that would improve the service we currently offer to you?

Question 11.

Please state your/ the patient's age:

Question 12.

Please state your/ the patient's Ethnic Origin:

White

Asian or Asian British

Mixed

Black or Black British

Other Ethnic Group