The Diagnostic Prostate Service

Date: March 2002

 

At the West Suffolk Hospitals NHS Trust we are committed to providing the highest possible care to our patients.

 

We would like to know what you thought of the service provided to you by our department. This information will help us to improve our standards of care. This work may also lead to the formation of a Patient Group.

 

Please return the completed questionnaire if you feel able to do so, a self-addressed envelope is provided.  Your answers will be treated in the strictest confidence, and will be anonymous unless you wish to fill in your name and address.

If you have any questions please contact my office on  01284 712739 or Urology Specialist Nurses 01284 712735

	What was the date of your visit to the Urology Clinic? Please enter details in the box.

 

Many thanks for your help.

 

Lynn Virciglio

Date:

Project Assistant

 

 

 

		Please Tick
(M)  Was the wait between visiting your GP and receiving your Hospital appointment too long?		Yes		No
(N) During your treatment did you understand the explanation of your condition, treatment, and/or test?		Yes		No
(O) During your visit, was your privacy respected whilst the doctors were examining you?		Yes		No
(P) Have you been given written information on how to contact any of your Specialist team outside the clinic times?		Yes		No
(Q) Were you happy about with the environment where you received your diagnosis?		Yes		No

 

Name:
Address:

 

The Diagnostic Prostate Service

 

Date: March 2002

 

At the West Suffolk Hospitals NHS Trust we are committed to providing the highest possible care to our patients.

 

We would like to know what you thought of the service provided to you by our department. This information will help us to improve our standards of care. This work may also lead to the formation of a Patient Group.

 

Please return the completed questionnaire if you feel able to do so, a self-addressed envelope is provided.  Your answers will be treated in the strictest confidence, and will be anonymous unless you wish to fill in your name and address.

If you have any questions please contact my office on  01284 712739 or Urology Specialist Nurses 01284 712735

	What was the date of your visit to the Urology Clinic? Please enter details in the box.

 

Many thanks for your help.

 

Lynn Virciglio

Date:

Project Assistant

 

 

 

 

		Please Tick
(M) Was the wait between receiving the date of your Hospital appointment and attending the Hospital  too long?		Yes		No
(N) During your treatment, did the staff ever talk about you as if you were not there?		Yes		No
(O) Did you feel comfortable with the surroundings where your examination took place?		Yes		No
P) Were you satisfied with the support  from the Specialist team during your visit?		Yes		No
(Q) If you were told your results over the telephone, did the person identify themselves?		Yes		No

 

Name:
Address:

 

 

 

The Diagnostic Prostate Service

Date: March 2002

 

At the West Suffolk Hospitals NHS Trust we are committed to providing the highest possible care to our patients.

 

We would like to know what you thought of the service provided to you by our department. This information will help us to improve our standards of care. This work may also lead to the formation of a Patient Group.

 

Please return the completed questionnaire if you feel able to do so, a self-addressed envelope is provided.  Your answers will be treated in the strictest confidence, and will be anonymous unless you wish to fill in your name and address.

If you have any questions please contact my office on  01284 712739 or Urology Specialist Nurses 01284 712735

	What was the date of your visit to the Urology Clinic? Please enter details in the box.

 

Many thanks for your help.

 

Lynn Virciglio

Date:

Project Assistant

 

 

 

		Please Tick
(M) Were you clear who you were due to meet at your first visit?		Yes		No
(N) During your treatment, did it ever happen that one member of staff said one thing about your condition or treatment, and another said something different?		Yes		No
(O) During your visit, did the doctors or nurses tell you about the possible side effects of your procedure or other treatment?		Yes		No
(P)    Were you satisfied with the information you received?		Yes		No
(Q)  During your follow up visit, were you involved in the decisions about your treatment and care as much as you wanted?		Yes		No
(M)  During your clinic visit did you have the opportunity to see the specialist nurse?		Yes		No

 

Name:
Address:

 

 

 

The Diagnostic Prostate Service

Date: March 2002

 

At the West Suffolk Hospitals NHS Trust we are committed to providing the highest possible care to our patients.

 

We would like to know what you thought of the service provided to you by our department. This information will help us to improve our standards of care. This work may also lead to the formation of a Patient Group.

 

Please return the completed questionnaire if you feel able to do so, a self-addressed envelope is provided.  Your answers will be treated in the strictest confidence, and will be anonymous unless you wish to fill in your name and address.

If you have any questions please contact my office on  01284 712739 or Urology Specialist Nurses 01284 712735

	What was the date of your visit to the Urology Clinic? Please enter details in the box.

 

Many thanks for your help.

 

Lynn Virciglio

Date:

Project Assistant

 

 

			Please Tick
(M) Were you able to find the Department easily?			Yes		No
(N) Did you feel confident in the way your tests were undertaken?			Yes		No
(O) During your visit, were you asked to sign a consent form for your treatment?			Yes		No
(P) Are you aware that your results are discussed by a team of Specialists called a Multidisciplinary Team who are involved in your care?			Yes		No
(Q)    Do you feel enough time was spent telling you your results?			Yes		No
(R)    When you were told your results were you told what happens next?			Yes		No
Name:
Address: