Early Supported Discharge Program Evaluation Form
Please complete this form to provide feedback on the Early Supported Discharge Program. Your insights will help us evaluate and improve our services.
Your role in the program
*
Please Select
Patient
Family Member/Caregiver
Healthcare Professional
Other
Location of the program
*
How long have you been involved with the program?
*
Please Select
Less than 1 month
1–3 months
3–6 months
More than 6 months
How would you rate the overall effectiveness of the program?
*
1
2
3
4
5
How satisfied are you with the support provided during the discharge process?
*
Not satisfied
1
2
3
4
Very satisfied
5
1 is Not satisfied, 5 is Very satisfied
How would you rate the communication between staff and participants?
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Were your needs adequately addressed by the program?
*
Yes
Partially
No
What positive outcomes have you observed as a result of participating in the program?
What challenges or barriers did you experience, if any?
Please provide any suggestions for improvement.
Submit Evaluation
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