Healthcare Visitor Policy Feedback Survey
Share your feedback on our visitor policy to help us improve the experience and safety for all.
What is your role?
*
Patient
Visitor
Staff
Other
Which department or ward did your visit relate to?
*
Please Select
Emergency
Surgery
Maternity
Pediatrics
Intensive Care
Outpatient
Other
How satisfied are you with the current visitor policy?
*
1
2
3
4
5
How clear was the information provided about the visitor policy?
*
Not clear at all
1
2
3
4
Extremely clear
5
1 is Not clear at all, 5 is Extremely clear
How did you receive information about the visitor policy?
*
Hospital website
On-site signage
Staff communication
Printed materials
Other
Please indicate your level of agreement with the following statements about the visitor policy:
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The visitor policy is easy to understand.
1
2
3
4
5
The policy is fair to patients and visitors.
6
7
8
9
10
The policy helps ensure safety.
11
12
13
14
15
The policy is communicated effectively.
16
17
18
19
20
Did you experience any difficulties due to the visitor policy?
*
Yes
No
If yes, please describe the difficulties you faced.
What suggestions do you have for improving the visitor policy?
Would you like to be contacted for follow-up regarding your feedback?
Yes
No
If yes, please provide your email address.
example@example.com
Submit Feedback
Should be Empty: