Compliments, Complaints and Feedback

Full Name *

Date of procedure *


Which location did you have your procedure at?*
Hampton Day Hospital (Hampton East)Knox Day Hospital (Bayswater)Bayside Day Procedure Centre (Frankston)Rosebud Day Hospital (Rosebud)Casey Day Procedure Centre (Narre Warren)

1. My views and concerns were listened to *
AlwaysMostlySometimesRarelyNeverDidn’t apply

2. My individual needs were met [if answer always/mostly, skip to Q4] * AlwaysMostlySometimesRarelyNever

3. When a need could not be met, staff explained why *
AlwaysMostlySometimesRarelyNever

4. I felt cared for *
AlwaysMostlySometimesRarelyNever

5. I was involved as much as I wanted in making decisions about my treatment and care *
AlwaysMostlySometimesRarelyNever

6. I was kept informed as much as I wanted about my treatment and care *
AlwaysMostlySometimesRarelyNever

7. As far as I could tell, the staff involved in my care communicated with each other about my treatment *
AlwaysMostlySometimesRarelyNeverDidn’t apply

8. I received pain relief that met my needs *
AlwaysMostlySometimesRarelyNeverDidn’t apply

9. When I was in the hospital, I felt confident in the safety of my treatment and care *
AlwaysMostlySometimesRarelyNever

10. I experienced unexpected harm or distress as a result of my treatment or care *
Yes, physical harmYes, emotional distressYes, bothNo

11. My harm or distress was discussed with me by staff *
YesNoNot SureDidn’t want to discuss itNot Applicable, I did not experience any harm or distress

12. Overall, the quality of the treatment and care I received was *
Very GoodGoodAveragePoorVery Poor

Please provide any additional feedback in the comment section below.

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