In-Patient and Visitor Survey

Why are we asking for your feedback?

Here at Myton we are always looking for ways to improve what we do and make sure we are delivering consistently high standards of care to our patients and their loved ones. By answering these questions you will be helping us to do just that! This survey is anonymous and your answers and any information you give will be treated in the strictest confidence.

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* Are you a patient at Myton or are you visiting a patient?

In Patient

Family Member of Patient (visiting)

Friend of Patient (visiting)

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* Select Hospice Site (Question Does Not Need to be Asked!)

Coventry

Warwick

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* Please rate the follow components of our service using the scores below:

	Poor	Fair	Good	Excellent
Staff Conduct	Staff Conduct Poor	Staff Conduct Fair	Staff Conduct Good	Staff Conduct Excellent
Cleanliness	Cleanliness Poor	Cleanliness Fair	Cleanliness Good	Cleanliness Excellent
Food	Food Poor	Food Fair	Food Good	Food Excellent
Hospice Facilities	Hospice Facilities Poor	Hospice Facilities Fair	Hospice Facilities Good	Hospice Facilities Excellent
Care Received	Care Received Poor	Care Received Fair	Care Received Good	Care Received Excellent

Please Answer Yes/No As Appropriate to the following questions:

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* Did you feel staff showed respect for you/and/or Your Relative/Friend?

Yes

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* Did you feel privacy and dignity were maintained throughout?

Yes

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* Was there the opportunity to discuss what mattered most?

Yes

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* Did you feel care decisions were discussed with you/and/or Your Relative/Friend?

Yes

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* Were there opportunities to ask any questions throughout the stay?

Yes

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* Has the hospice made a difference to how you cope with your condition?

Yes

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* Has your overall experience in the hospice been positive?

Yes

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* Do you have any other comments you would like to make?

Thank you for your feedback, if there is anything which you feel could be improved during your stay or visit please contact a member of staff