I Share your experience with us

1 Personal Particulars
a I am...

1Patient

2Caregiver

3Relative

4Visitor
b Your Name

OK

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c Patient's Name

OK

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2 Purpose of Visit
a What was the primary purpose of your visit to SKH?

1Outpatient Services (Clinic)

2Inpatient Services (Ward)

3Emergency Services

4Allied Health Services (e.g. Therapy, MSW, Radiology, CMC, Rehab)

II Outpatient Services

a Which of these clinic or services did you visit or use?

1 Level 2 (Dental Clinic)

2 Level 2 (Endoscopy Centre)

3 Level 2 (Infectious Diseases)

4 Level 2 (Outpatient Antibiotic Therapy (OPAT))

5 Level 2 (Radiology on 2)

6 Level 3 (Hand Surgery)

7 Level 3 (Occupational Medicine)

8 Level 3 (Orthopaedics Surgery)

9 Level 3 (Radiology on 3)

10 Level 3 (Rehabilitation Medicine)

11 Level 3 (Sports and Exercise Medicine)

12 Level 4 (Anticoagulation Management)

13 Level 4 (General/Vascular Surgery)

14 Level 4 (NHCS Cardiology @ SKH)

15 Level 4 (Obstetrics & Gynaecology)

16 Level 4 (Paediatrics)

17 Level 4 (Radiology on 4)

18 Level 4 (Respiratory Medicine)

19 Level 4 (Thoracic Surgery)

20 Level 5 (Breast Centre)

21 Level 5 (Dermatology)

22 Level 5 (General Medicine)

23 Level 5 (Haematology)

24 Level 5 (Mind & Body Integration)

25 Level 5 (Neurology)

26 Level 5 (Neurosurgery)

27 Level 5 (Palliative Medicine)

28 Level 5 (Plastic Surgery)

29 Level 5 (Radiology on 5)

30 Level 5 (Rheumatology)

31 Level 6 (Ear, Nose, Throat (ENT))

32 Level 6 (Gastroenterology & Hepatology)

33 Level 6 (General Surgery)

34 Level 6 (General/Colorectal Surgery)

35 Level 6 (General/Hepatobiliary Surgery)

36 Level 6 (General/Upper GI And Bariatric Surgery)

37 Level 6 (Head & Neck Surgery)

38 Level 6 (Sleep Medicine)

39 Level 7 (Diabetes and Endocrinology)

40 Level 7 (Geriatric Medicine)

41 Level 7 (Renal Medicine)

42 Level 7 (Urology)

43 Level 8 (Acupuncture)

44 Level 8 (Pain Management)

45 Level B1M (Occupational Medicine)
1 Communication with Counter Staff / Patient Services Associates (PSA)
a How often did the counter staff/PSA treat you with courtesy and respect?

1 Always

2 Usually

3 Sometimes

4 Never
b How often did the counter staff/PSA listen carefully to you?

1 Always

2 Usually

3 Sometimes

4 Never
c How often did the counters staff/PSA explain things in a way you could understand?

1 Always

2 Usually

3 Sometimes

4 Never
2 Your Care from Nurses / Room Assistants
a How often did the nurses/room assistants treat you with courtesy and respect?

1 Always

2 Usually

3 Sometimes

4 Never
b How often did the nurses/room assistants listen carefully to you?

1 Always

2 Usually

3 Sometimes

4 Never
c How often did the nurses/room assistants explain things in a way you could understand?

1 Always

2 Usually

3 Sometimes

4 Never
3 Your Care from Doctors
a How often did the doctors treat you with courtesy and respect?

1 Always

2 Usually

3 Sometimes

4 Never
b How often did the doctors listen carefully to you?

1 Always

2 Usually

3 Sometimes

4 Never
c How often did the doctors explain things in a way you could understand?

1 Always

2 Usually

3 Sometimes

4 Never
4 When you left the Clinic
a How often were there good communication between different staff attending to you?

1 Always

2 Usually

3 Sometimes

4 Never
b Did you get information about what symptoms or health problems to look out for after you left the clinic?

1 Yes, definitely

2 Yes, mostly

3 Yes, somewhat

4 No
5 Environment & Facilities
a How often were areas around you clean?

1 Always

2 Usually

3 Sometimes

4 Never
6 Overall Rating
a During your visit, the staff involved you and/or your family in decisions about your care and treatment after you left the clinic.

1 Strongly agree

2 Agree

3 Disagree

4 Strongly disagree
b Would you recommend Sengkang General Hospital to someone you know who needs similar treatment?

1 Definitely yes

2 Probably yes

3 Probably no

4 Definitely no
c If there is one key area that SKH has impressed you, what will it be?

OK

press ENTER
d If there is one key area that SKH could improve on, what will it be?

OK

press ENTER
7 Commendation of Staff
a Are there any of our staff you would like to compliment?

1 Yes

2 No
b Name of Staff

OK

press ENTER
c Clinic / Department

OK

press ENTER
d Describe the service act that made an impression on you.

OK

press ENTER
8 Give a Gift of Health
a SKH has established the SKH Better Health Fund to help our needy patients and support research, education and patient care initiatives.

Would you like to make a donation and/or find out more? Our SKH Development Office will contact you to share more information if you indicate "Yes".

1 Yes

2 No

III Emergency Services

1 After checking-in to the Emergency Department
a How often did the counter staff treat you with courtesy and respect?

1 Always

2 Usually

3 Sometimes

4 Never
b How often did the counter staff/PSA listen carefully to you?

1 Always

2 Usually

3 Sometimes

4 Never
c How often did the counter staff/PSA explain things in a way you could understand?

1 Always

2 Usually

3 Sometimes

4 Never
d How often did the nurses treat you with courtesy and respect?

1 Always

2 Usually

3 Sometimes

4 Never
e How often did the nurses listen carefully to you?

1 Always

2 Usually

3 Sometimes

4 Never
f How often did the nurses explain things in a way you could understand?

1 Always

2 Usually

3 Sometimes

4 Never
g How often did you have confidence and trust in the nurses treating you?

1 Always

2 Usually

3 Sometimes

4 Never
h Were you comfortable talking with nurses about your worries and concerns?

1 Yes, definitely

2 Yes, mostly

3 Yes, somewhat

4 No

5 Did not have any worries or concerns
2 Seeing a provider in the Emergency Department
a Were you seen by a doctor in a timely manner?

1 Yes

2 No
b How often did the doctors treat you with courtesy and respect?

1 Always

2 Usually

3 Sometimes

4 Never
c How often did the doctors listen carefully to you?

1 Always

2 Usually

3 Sometimes

4 Never
d How often did the doctors explain things in a way you could understand?

1 Always

2 Usually

3 Sometimes

4 Never
e Were doctors fully aware of your important medical information before giving you treatment?

1 Yes, definitely

2 Yes, mostly

3 Yes, somewhat

4 No
f Were you comfortable talking with doctors about your worries and concerns?

1 Yes, definitely

2 Yes, mostly

3 Yes, somewhat

4 No

5 Did not have any worries or concerns
g How often did you have confidence and trust in the doctors treating you?

1 Always

2 Usually

3 Sometimes

4 Never
3 Radiology (Answer if applicable)
a How often did the radiographer who performed your image procedure treat you with courtesy and respect?

1 Always

2 Usually

3 Sometimes

4 Never
b How often did the radiographer who performed your image procedure listen carefully to you?

1 Always

2 Usually

3 Sometimes

4 Never
c How often did the radiographer who performed your image procedure explain things in a way you could understand?

1 Always

2 Usually

3 Sometimes

4 Never
d How often did the radiographer who performed your image procedure treat you with kindness and compassion?

1 Always

2 Usually

3 Sometimes

4 Never
e How often did you have confidence and trust in the radiographer who performed your image procedure?

1 Always

2 Usually

3 Sometimes

4 Never
4 Physiotherapy (Answer if applicable)
a How often did the physiotherapist treat you with courtesy and respect?

1 Always

2 Usually

3 Sometimes

4 Never
b How often did the physiotherapist listen carefully to you?

1 Always

2 Usually

3 Sometimes

4 Never
c How often did the physiotherapist explain things in a way you could understand?

1 Always

2 Usually

3 Sometimes

4 Never
d How often did the physiotherapist treat you with kindness and compassion?

1 Always

2 Usually

3 Sometimes

4 Never
e How often did you have confidence and trust in the physiotherapist(s) providing care to you?

1 Always

2 Usually

3 Sometimes

4 Never
5 Pharmacy (Answer if applicable)
a How often did the pharmacy staff treat you with courtesy and respect?

1 Always

2 Usually

3 Sometimes

4 Never
b How often did the pharmacy staff listen carefully to you?

1 Always

2 Usually

3 Sometimes

4 Never
c How often did the pharmacy staff explain things in a way you could understand?

1 Always

2 Usually

3 Sometimes

4 Never
d How often did the pharmacy staff treat you with kindness and compassion?

1 Always

2 Usually

3 Sometimes

4 Never
e How often did you have confidence and trust in the pharmacy staff providing care to you?

1 Always

2 Usually

3 Sometimes

4 Never
f Before giving you medicine, the pharmacy staff explained clearly what the medicine was for.

1 Strongly agree

2 Agree

3 Disagree

4 Strongly disagree
g Before giving you new medicine, the pharmacy staff described possible side effects in a way you could understand.

1 Strongly agree

2 Agree

3 Disagree

4 Strongly disagree
6 Your Other Experiences in the Emergency Department
a Did you have your blood, x-ray or any other tests taken?

1 Yes

2 No
b Were your tests conducted in a timely manner?

1 Yes, definitely

2 Yes, mostly

3 Yes, somewhat

4 No
c Were your test results explained in a way that you could understand?

1 Yes, definitely

2 Yes, mostly

3 Yes, somewhat

4 No
d Do you think that you received the right treatment in the Emergency Department (e.g. tests, diagnosis, medication, etc)?

1 Yes, definitely

2 Yes, mostly

3 Yes, somewhat

4 No
e How often were the different doctors and nurses consistent with each other in providing you information and care?

1 Always

2 Usually

3 Sometimes

4 Never
f How often was your family or someone close to you allowed to be with you as much as you wanted?

1 Always

2 Usually

3 Sometimes

4 Never
g How often did you have enough input or say in your care?

1 Always

2 Usually

3 Sometimes

4 Never
7 Environment & Facilities
a How often did areas around you appear clean?

1 Always

2 Usually

3 Sometimes

4 Never
8 Going Home
a Did the staff explain what to do if problems or symptoms continued, got worse, or come back?

1 Yes definitely

2 Yes mostly

3 Yes somewhat

4 No
9 Overall Rating of the Emergency Department Services
a During your visit, the staff involved you and/ or your family in decisions about your care and treatment after you left the Emergency Department.

1 Strongly agree

2 Agree

3 Disagree

4 Strongly disagree
b Would you recommend Sengkang General Hospital to someone you know who needs similar treatment?

1 Definitely yes

2 Probably yes

3 Probably no

4 Definitely no
c If there is one key area that SKH has impressed you, what will it be?

OK

press ENTER
d If there is one key area that SKH could improve on, what will it be?

OK

press ENTER
10 Commendations for Quality Service/Compliments
a Are there any of our staff you would like to compliment?

1 Yes

2 No
b Name of Staff

OK

press ENTER
c Ward / Department

OK

press ENTER
d Describe the service act that made an impression on you.

OK

press ENTER
11 Give a Gift of Health
a SKH has established the SKH Better Health Fund to help our needy patients and support research, education and patient care initiatives.

Would you like to make a donation and/or find out more? Our SKH Development Office will contact you to share more information if you indicate "Yes".

1 Yes

2 No

IV Inpatient Services

a Which ward were you admitted to?

1 Ward 110

2 Ward 19

3 Ward 18

4 Ward 17

5 Ward 16

6 Ward 14

7 Ward 13A - CCU

8 Ward 13

9 Ward 210

10 Ward 29

11 Ward 28

12 Ward 27

13 Ward 26

14 Ward 25

15 Ward 24

16 Ward 23

17 Ward 310

18 Ward 39

19 Ward 38

20 Ward 37

21 Ward 36

22 Ward 34

23 Ward 33

24 Ward 410

25 Ward 49

26 Ward 48

27 Ward 47

28 Ward 46

29 Ward 45

30 Ward 45A - Renal

31 Ward 44

32 Ward 510

33 Ward 59

34 Ward 58

35 Ward 57

36 Ward 56

37 Ward 610

38 Ward 69

39 Ward 68

40 Ward 67

41 Surgery on 2/3
b Discharge Date (DD/MM/YYYY)

OK

press ENTER
1 Communication with Counter Staff / Patient Service Associates (PSAs)
a How often did the counter staff / PSAs treat you with courtesy and respect?

1 Always

2 Usually

3 Sometimes

4 Never
b How often did the counter staff / PSA listen carefully to you?

1 Always

2 Usually

3 Sometimes

4 Never
c How often did the counter staff / PSAs explain things in a way you could understand?

1 Always

2 Usually

3 Sometimes

4 Never
2 Your Care from Nurses
a How often did the nurses treat you with courtesy and respect?

1 Always

2 Usually

3 Sometimes

4 Never
b How often did the nurses listen carefully to you?

1 Always

2 Usually

3 Sometimes

4 Never
c How often did the nurses explain things in a way you could understand?

1 Always

2 Usually

3 Sometimes

4 Never
3 Your Care from Doctors
a How often did the doctors treat you with courtesy and respect?

1 Always

2 Usually

3 Sometimes

4 Never
b How often did the doctors listen carefully to you?

1 Always

2 Usually

3 Sometimes

4 Never
c How often did the doctors explain things in a way you could understand?

1 Always

2 Usually

3 Sometimes

4 Never
d How often were you able to discuss your worries or concerns with the doctors?

1 Always

2 Usually

3 Sometimes

4 Never

5 Did not have any worries or concerns
4 Food Services
a How often was the taste of your food excellent?

1 Always

2 Usually

3 Sometimes

4 Never
b How often was the temperature of your food acceptable?

1 Always

2 Usually

3 Sometimes

4 Never
5 Environment & Facilities
a How often were your room and toilet kept clean?

1 Always

2 Usually

3 Sometimes

4 Never
b How often was the area around your room quiet at night?

1 Always

2 Usually

3 Sometimes

4 Never
6 Your Experience in the Hospital
a How often did you get help in getting to the toilet or in using a bedpan as soon as you wanted?

1 Always

2 Usually

3 Sometimes

4 Never
b How often did hospital staff talk with you about how much pain you had?

1 Always

2 Usually

3 Sometimes

4 Never

5 Not Applicable
7 Communication about Medicines
a Upon your discharge, were you given medicine you had not taken before?

1 Yes

2 No
b Upon your discharge, the pharmacy staff explained clearly what the medicine was for.

1 Strongly agree

2 Agree

3 Disagree

4 Strongly disagree
c Upon your discharge, the pharmacy staff described possible side effects of the new medicine in a way you could understand.

1 Strongly agree

2 Agree

3 Disagree

4 Strongly disagree
d When you left the hospital, you clearly understood how to take each of your medications.

1 Strongly agree

2 Agree

3 Disagree

4 Strongly disagree
8 Your Care from Pharmacists and Allied Health Professionals (AHPs)
a Were you attended to by any Pharmacist or Allied Health Professional (AHP) during this hospital stay?

1 Yes

2 No
b Please select the AHP who attended to you during this hospital stay, and whom you would like to give feedback on

1 Audiology

2 Radiology

3 Dietetics

4 Medical Social Services

5 Occupational Therapy

6 Optometry

7 Pathology

8 Pharmacy

9 Physiotherapy

10 Podiatry

11 Psychology

12 Respiratory Therapy

13 Speech Therapy

14 Others
c Please state :

OK

press ENTER
d How often did the Pharmacist/AHP treat you with courtesy and respect?

1 Always

2 Usually

3 Sometimes

4 Never
e How often did the Pharmacist/AHP listen carefully to you?

1 Always

2 Usually

3 Sometimes

4 Never
f How often did the Pharmacist/AHP explain things in a way you could understand?

1 Always

2 Usually

3 Sometimes

4 Never
g How often did you have confidence and trust in the Pharmacist/AHP providing care to you?

1 Always

2 Usually

3 Sometimes

4 Never
h Were you taught all you needed to know about how to continue with your rehabilitation /therapy/ intervention at home?

1 Yes, definitely

2 Yes, mostly

3 Yes, somewhat

4 No
9 When You Left the Hospital
a After discharge, you understood the symptoms and health problems to look out for.

1 Strongly agree

2 Agree

3 Disagree

4 Strongly disagree
b During your stay, the staff involved you and/or your family in decisions about what your care and treatment would be after discharge.

1 Strongly agree

2 Agree

3 Disagree

4 Strongly disagree
10 Overall Rating
a Would you recommend Sengkang General Hospital to someone you know who needs similar treatment?

1 Definitely yes

2 Probably yes

3 Probably no

4 Definitely no
b If there is one key area that SKH has impressed you, what will it be?

OK

press ENTER
c If there is one key area that SKH could improve on, what will it be?

OK

press ENTER
11 Commendation for Quality Service
a Are there any of our staff you would like to compliment?

1 Yes

2 No
b Name of Staff

OK

press ENTER
c Department / Ward

OK

press ENTER
d Describe the service act that made an impression on you.

OK

press ENTER
12 Give a Gift of Health
a SKH has established the SKH Better Health Fund to help our needy patients and support research, education and patient care initiatives.

Would you like to make a donation and/or find out more? Our SKH Development Office will contact you to share more information if you indicate "Yes".

1 Yes

2 No

V Allied Health Services

1 Communication with Counter Staff/Patient Service Associates (PSA)
a How often did the counter staff/PSA treat you with courtesy and respect?

1 Always

2 Usually

3 Sometimes

4 Never
b How often did the counter staff/PSA listen carefully to you?

1 Always

2 Usually

3 Sometimes

4 Never
c How often did the counter staff/PSA explain things in a way you could understand?

1 Always

2 Usually

3 Sometimes

4 Never
2 Allied Health Professionals (AHPs)
a Select one of the following service that you would like to give feedback on

1 Occupational Therapy

2 Physiotherapy

3 Podiatry

4 Psychology

5 Speech Therapy

6 Clinical Measurement Centre

7 Audiology

8 Dietetics

9 Radiology

10 Medical Social Services
b How often did the AHP treat you with courtesy and respect?

1 Always

2 Usually

3 Sometimes

4 Never
c How often did the AHP listen carefully to you?

1 Always

2 Usually

3 Sometimes

4 Never
d How often did the AHP explain things in a way you could understand?

1 Always

2 Usually

3 Sometimes

4 Never
e How often did the AHP treat you with kindness and compassion?

1 Always

2 Usually

3 Sometimes

4 Never
f How often did you have confidence and trust in the AHP providing care to you?

1 Always

2 Usually

3 Sometimes

4 Never
g Were you taught all you needed to know about how to continue your rehabilitation/therapy/intervention at home? (Not applicable for Radiology and Medical Social Services)

1 Yes, definitely

2 Yes, mostly

3 Yes, somewhat

4 No
3 Medical Social Services (Answer if applicable)
a Were you able to obtain information and assistance for your financial, care and/or emotional needs during your visit?

1 Yes

2 No
b Were the social worker(s) from this hospital available to help you during your stay and/or after you left?

1 Yes definitely

2 Yes mostly

3 Yes somewhat

4 No
4 Pharmacy (Answer if applicable)
a How often did the pharmacy staff treat you with courtesy and respect?

1 Always

2 Usually

3 Sometimes

4 Never
b How often did the pharmacy staff listen carefully to you?

1 Always

2 Usually

3 Sometimes

4 Never
c How often did the pharmacy staff explain things in a way you could understand?

1 Always

2 Usually

3 Sometimes

4 Never
d How often did the pharmacy staff treat you with kindness and compassion?

1 Always

2 Usually

3 Sometimes

4 Never
e How often did you have confidence and trust in the pharmacy staff providing care to you?

1 Always

2 Usually

3 Sometimes

4 Never
f Before giving you medicine, the pharmacy staff explained clearly what the medicine was for.

1 Strongly agree

2 Agree

3 Disagree

4 Strongly disagree
g Before giving you new medicine, the pharmacy staff described possible side effects in a way you could understand.

1 Strongly agree

2 Agree

3 Disagree

4 Strongly disagree
5 Environment & Facilities
a How often did areas around you appear clean?

1 Always

2 Usually

3 Sometimes

4 Never
6 Overall Rating of the Hospital
a Would you recommend Sengkang General Hospital to someone you know who needs similar treatment?

1 Definitely yes

2 Probably yes

3 Probably no

4 Definitely no
b If there is one key area that SKH has impressed you, what will it be?

OK

press ENTER
c If there is one key area that SKH could improve on, what will it be?

OK

press ENTER
7 Commendation for Staff
a Are there any of our staff you would like to compliment?

1 Yes

2 No
b Name of Staff

OK

press ENTER
c Department

OK

press ENTER
d Describe the service act that made an impression on you.

OK

press ENTER
8 Give a Gift of Health
a SKH has established the SKH Better Health Fund to help our needy patients and support research, education and patient care initiatives.

Would you like to make a donation and/or find out more? Our SKH Development Office will contact you to share more information if you indicate "Yes".

1 Yes

2 No

VI Your particulars

a Thank you for your submission. To help us review your feedback, please provide us the following particulars
b Contact Number

OK

press ENTER
c Date of Visit (DD/MM/YYYY)

OK

press ENTER
d Email Address

OK

press ENTER
e Address

OK

press ENTER
f Patient's NRIC (please provide to assist us to review your feedback or specific issues raised)

OK

press ENTER
g Comments or Remarks

OK

press ENTER

By providing the information set out in this form and submitting the same to us, I confirm that I have read, understood and consented to the SingHealth Data Protection Policy, a copy of which is available here.

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