Patient Questionnaire

Your feedback is important to us. It helps us improve the quality of our service. To be completed by the patient, parent or guardian after the operation.

When was the operation done (date)?

What was the name of the doctor?

Was the operation explained properly?

If 'No' please state details missed

Was the operation satisfactory?

If 'No' please state dissatisfaction in detail

Was the post operative recovery satisfactory?

If 'No' please state problems in detail

Was post-operative contact with the clinic necessary?

How was this contact made?

Was this contact satisfactory

If 'No' please state dissatisfaction in detail

How would you rate the booking procedure?

How would you rate the pre-operative information given?

How would you rate the respect shown to patient and family at clinic?

How would you rate the booking procedure?

How would you rate the clinic doctor?

How would you rate the clinic nurses?

How would you rate the clinic overall?

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By submitting this form, I consent to Thornhill Circumcision Centre to contact me via email or telephone to help me with my enquiry.