The Arm Clinic
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Patient Feedback

Step 1 of 2

50%

Satisfaction Survey

Your Name
MM slash DD slash YYYY

Tick the box that applies to you the most.

Your initial enquiry was dealt with in a polite and efficient manner.(Required)
The information given at your initial enquiry was helpful and informative.(Required)
The documents sent before your first consultation were clear and easy to understand.(Required)
The documents sent prior to your surgery were clear and easy to understand.(Required)
You were given the appropriate information when needed.(Required)
You were happy with the overall service that you received.(Required)
You were happy with the hospital environment.(Required)
You were happy with the hospital parking facilities.(Required)
You were happy with members of staff at the hospital.(Required)
You were happy with the punctuality of your appointment.(Required)
You were happy with the length of your appointment.(Required)
You were happy with the information given at the appointment.(Required)

Hospital ratings

Which hospital(s) did you attend?(Required)
How would you rate this hospital (0-10) ?
How would you rate this hospital (0-10) ?
How would you rate this hospital (0-10) ?
How would you rate this hospital (0-10) ?

Patient Feedback

This questionnaire asks about your shoulder pain and its impact on your lifestyle. We use this as a tool to achieve a better understanding of how your shoulder is affecting you and ultimately improves the service that we offer you.

Step 1 of 2

50%

Satisfaction Survey

Your Name
MM slash DD slash YYYY

Tick the box that applies to you the most.

Your initial enquiry was dealt with in a polite and efficient manner.(Required)
The information given at your initial enquiry was helpful and informative.(Required)
The documents sent before your first consultation were clear and easy to understand.(Required)
The documents sent prior to your surgery were clear and easy to understand.(Required)
You were given the appropriate information when needed.(Required)
You were happy with the overall service that you received.(Required)
You were happy with the hospital environment.(Required)
You were happy with the hospital parking facilities.(Required)
You were happy with members of staff at the hospital.(Required)
You were happy with the punctuality of your appointment.(Required)
You were happy with the length of your appointment.(Required)
You were happy with the information given at the appointment.(Required)

Hospital ratings

Which hospital(s) did you attend?(Required)
How would you rate this hospital (0-10) ?
How would you rate this hospital (0-10) ?
How would you rate this hospital (0-10) ?
How would you rate this hospital (0-10) ?

The Wilmslow Hospital,
52 Alderley Rd,
Wilmslow,
Cheshire,
SK9 1NY

Phone: 01625 545071/2/3

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