PALS, Complaints, Concerns and Compliments Survey Question Title * 1. Did you receive appropriate information on the NHS Complaints procedure or an explanation of what we would do?ie. The process by which we investigate and respond to your complaint Yes No Question Title * 2. Did you feel that your concerns were treated seriously and with sensitivity? Yes No Question Title * 3. Did you feel we addressed all the points you made? Yes No Question Title * 4. Did we provide a clear and understandable response? Yes No Question Title * 5. Did you feel your complaint was responded to within a reasonable period of time? Yes No Question Title * 6. Did we keep you sufficiently informed if there was a delay in providing you with a response? Yes No N/A Question Title * 7. Did you feel you were treated differently as a result of your complaint? Treated Better No Difference Treated Worse Question Title * 8. Overall, how do you feel your complaint was handled? Very Well Well Average Poor Very Poor Question Title * 9. Are there any other comments you would like to make? Question Title * 10. Which service did your issue/complaint relate to? Question Title * 11. The Department of Health requires us to collect the following information, so we would be most grateful if you could complete the following:-Please select approprately Male Female Question Title * 12. How would you describe your Ethnic Origin?These classifications are those recommended by the Commission for Racial Equality)Please select appropriately:- White British White Irish any other White background Mixed White / Black Caribbean Mixed White / Black African Mixed White / Asian any other Mixed background Asian / British Indian Asian / British Pakistani Asian / British Bangladeshi any other Asian background Black / British Caribbean Black / British African any other Black background any other Ethnic Group Question Title * 13. Thank you for your help Date Date Done
