Peterborough Regional Health Centre
Patient Survey

Our Aim
Our primary aim is to provide the best care for you while you are at the hospital.

We Want Your Feedback
Your feedback about our service is very important to us.
Please take a few minutes to complete this questionnaire. We welcome the opportunity to review your comments and suggestions.
You can fill out this questionnaire electronically (from your bedside terminal in hospital, or on our website) or on paper.

Your response is confidential. You do not have to identify yourself on the questionnaire.

Questionnaire

Answer YES or NO to each of the following questions: Add comments if desired.
Were you satisfied with your care?
Yes No
If no, please explain:
Did your care providers introduce themselves and tell you what they were doing?
Yes No
If no, please explain:
Did your care providers wear a name tag that was clearly visible?
Yes No
If no, please explain:
Were you satisfied with the meals?
Yes No
If no, please explain:
Was your room (clinic or outpatient care area) tidy and well maintained?
Yes No
If no, please explain:
Were all hospital staff, physicians and volunteers pleasant and friendly?
Yes No
If no, please explain:
Were you treated with dignity and respect?
Yes No
If no, please explain:
Did your care team respond promptly to your calls for assistance?
Yes No
If no, please explain:
Did your care providers wash their hands before providing any kind of tests or treatment to you?
Yes No
If no, please explain:
Was your privacy and confidentiality maintained?
Yes No
If no, please explain:
Did you get the information you needed?
Yes No
If no, please explain:
Were you prepared for your discharge/departure?
Yes No
If no, please explain:
Help us serve our patients better.
Please check the areas in which you have been a patient during this hospital visit.
A2 C2 Diabetes Centre
A3 Intensive Care (ICU) C3 Breast Assessment Centre
A4 D1 Dialysis
A5 D2 Women’s Health Care Centre
A6 Rehabilitation Therapies Surgery and Outpatient Procedures
B2 Mental Health Services Labour and Delivery
B3 Diagnostic Imaging Special Care Nursery
B4 Orthopaedics and Cast Clinic Other
B5 Cardiac Catheterization    
B6 Cancer Care    
C1 Neuro and Breathing Assessment    
Identification (Optional):
Name:  
Date:  
Contact   
Thank you for taking the time to complete this survey.
 
 
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