Hull and East Riding Patient Satisfaction Survey

Hull and East Riding Fertility Patient Satisfaction Survey

Please complete the questionnaire circling the most appropriate number giving marks out of 5 for each question.
5 being the highest score and 1 being the lowest score

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* 1. Please state your treatment type.

Fresh

Frozen

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* 2. Was this your first cycle of treatment?

Yes

No

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* 3. Please state month of treatment

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* 4. Was your treatment NHS or Private?

NHS

Private

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* 5. When you attended the unit did you find the office staff

	1	2	3	4	5
Polite?	Polite? 1	Polite? 2	Polite? 3	Polite? 4	Polite? 5
Helpful?	Helpful? 1	Helpful? 2	Helpful? 3	Helpful? 4	Helpful? 5

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* 6. When telephoning the Clinic was your call answered promptly?

	1	2	3	4	5
Rating	Rating 1	Rating 2	Rating 3	Rating 4	Rating 5

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* 7. On the whole were you able to speak to the person you required? If not, did someone return your call within an appropriate timeframe?

	1	2	3	4	5
Rating	Rating 1	Rating 2	Rating 3	Rating 4	Rating 5

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* 8. Was the reception area appropriate to your needs? Did you find the leaflets and digital display (TV) information interesting? Please comment below.

	1	2	3	4	5
Rating	Rating 1	Rating 2	Rating 3	Rating 4	Rating 5

Comment as required,

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* 9. Where you kept waiting without an explanation for excessive periods of time? If so, please give details below

	1	2	3	4	5
Rating	Rating 1	Rating 2	Rating 3	Rating 4	Rating 5

Comment as required,

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* 10. Did you find the website and social media pages easy to navigate and was the content informative?

	1	2	3	4	5
Rating	Rating 1	Rating 2	Rating 3	Rating 4	Rating 5
Comment as required,

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* 11. At your consultation appointments were you given sufficient information?

	1	2	3	4	5
About your treatment plan	About your treatment plan 1	About your treatment plan 2	About your treatment plan 3	About your treatment plan 4	About your treatment plan 5
To make an informed decision	To make an informed decision 1	To make an informed decision 2	To make an informed decision 3	To make an informed decision 4	To make an informed decision 5

Question Title

* 12. When you attended for nursing appointments i.e. first appointments, scan appointments etc. did you feel the nurse allowed you time to ask questions?

	1	2	3	4	5
Rating	Rating 1	Rating 2	Rating 3	Rating 4	Rating 5

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* 13. When you had an intimate examination or procedure was the procedure explained beforehand and was your privacy and dignity maintained throughout?

	1	2	3	4	5
Rating	Rating 1	Rating 2	Rating 3	Rating 4	Rating 5

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* 14. During laboratory update phone calls did you feel the laboratory staff answered your questions clearly?

	1	2	3	4	5
Rating	Rating 1	Rating 2	Rating 3	Rating 4	Rating 5

Comment as required,

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* 15. If applicable, at embryo transfer did you feel you had sufficient information about the fertilisation rate, embryo quality, number of embryos for transfer and the possibility of embryo freezing?

	1	2	3	4	5
Rating	Rating 1	Rating 2	Rating 3	Rating 4	Rating 5

Comment as required,

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* 16. Overall, did you feel your views were listened to and incorporated into your plan of care?

	1	2	3	4	5
Rating	Rating 1	Rating 2	Rating 3	Rating 4	Rating 5

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* 17. Were you treated fairly and without discrimination?

	1	2	3	4	5
Rating	Rating 1	Rating 2	Rating 3	Rating 4	Rating 5

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* 18. Did you feel that your confidentiality was maintained at all times?

	1	2	3	4	5
During discussions	During discussions 1	During discussions 2	During discussions 3	During discussions 4	During discussions 5
Your medical notes	Your medical notes 1	Your medical notes 2	Your medical notes 3	Your medical notes 4	Your medical notes 5
Through written correspondence	Through written correspondence 1	Through written correspondence 2	Through written correspondence 3	Through written correspondence 4	Through written correspondence 5

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* 19. The Clinic has to comply with strict rules governing the sharing of your personal information with other healthcare professionals, including your GP. Was this explained to you during your cycle in a manner that you understood?

	1	2	3	4	5
Rating	Rating 1	Rating 2	Rating 3	Rating 4	Rating 5

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* 20. Please feel free to comment fully about any aspects of your treatment below, referring to question numbers if needed.

If you would like specific feedback on your answers please provide your details in order for us to contact you.

We would also be grateful if you could review us on our website.