Share Your Feedback About Urgent Treatment Centres

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Name of service 

(e.g. PRUH, Beckenham Beacon)

Required - Required.

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Date 

Required - Required.

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Time

Required - Required.

Did you seek help from another service before attending tis one 

Yes

No

If yes, which one?

This is required

Did a family member or friend come with you today?

Yes

No

If yes, were they allowed to sit with you? If no, did reception staff suggest somewhere for them to go?

This is required

What is your postcode?

How did you travel to the service

Car

Public transport

On foot

If you travelled by car how easy was it to park?

5 - Very easy

4 - Easy

3 - Neither easy nor difficult

2- Difficult

1 - Very difficult

What was your experience of reception staff?

5 -Very good

4 - Good

3 - Neither good nor bad

2 - Poor

1 - Very poor

N/A

Anything that was good or could be improved?

This is required

How long were you waiting to be seen by triage staff?

(Triage = explaining your symptoms to the nurse) 

What was your experience of the triage process?

5 - Very good

4 - Good

3 - Neither good 

2 - Poor 

1 - Very poor

N/A

Anything that was good or could be improved?

This is required

How long was the wait to be seen after triage?

Did you receive any information about how long you would have to wait today before you would be seen?

Yes

No

How would you rate the surroundings in the waiting room?

5 - Very good

4 - Good

3 - Neither good nor bad

2 - Poor

1 - Very poor 

Anything that was good or could be improved?

This is required

How would you rate the quality of treatment and care received?

5 - Very good

4 - Good

3 - Neither good nor bad

2 - Poor

1 - Very poor 

Do you have any other comment? 

Do you have special needs?

Yes

No

If yes, were any adjustments made for you during your visit?

This is required

How do you rate your overall experience? 

5 - Very good

4 - Good

3 - Neither good nor bad

2 - Poor

1 - Very poor 

Do you have any other comments?