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* 1. Name of person completing the survey

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* 2. Unit/Hospital completing on behalf of

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* 3. Transfer Service you are leaving feedback on

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* 4. Overall, How would you rate your experience of transferring patients using the Adult Critical Care Transfer Service?

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* 5. Please use this space to provide feedback on the service

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* 6. Are you happy for us to share this feedback directly with the Transfer Service?

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* 7. Would you like the Network (or Transfer Service) to follow up with you directly regarding this feedback?

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* 8. Please provide the best email address to contact you on, if wanting us to follow up with you:

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