I Share your experience with us
- 1 Personal Particulars
- a I am...
  
  1Patient
  
  2Caregiver
  
  3Relative
  
  4Visitor
- b Your Name
  
  OK
  
  press ENTER
- c Patient's Name
  
  OK
  
  press ENTER
- 2 Purpose of Visit
- a What was the primary purpose of your visit to SKH?
  
  1Outpatient Services
  
  2Inpatient Services
  
  3Emergency Services
  
  4Allied Health Services
II Outpatient Services
- a Which of these clinic or services did you visit or use?
  
  1 Level B1M (Occupational Medicine)
  
  2 Level 2 (Infectious Diseases)
  
  3 Level 2 (Outpatient Antibiotic Therapy (OPAT))
  
  4 Level 2 (Radiology on 2)
  
  5 Level 2 (Dental Clinic)
  
  6 Level 2 (Endoscopy Centre)
  
  7 Level 3 (Orthopaedics Surgery)
  
  8 Level 3 (Hand Surgery)
  
  9 Level 3 (Rheumatology)
  
  10 Level 3 (Radiology on 3)
  
  11 Level 4 (NHCS Cardiology @ SKH)
  
  12 Level 4 (Thoraic Surgery)
  
  13 Level 4 (Anticoagulation Management)
  
  14 Level 4 (General/Vascular Surgery)
  
  15 Level 4 (Respiratory Medicine)
  
  16 Level 4 (Radiology on 4)
  
  17 Level 4 (Rehabilitation Medicine)
  
  18 Level 4 (Internal Medicine)
  
  19 Level 4 (Obstetrics & Gynaecology)
  
  20 Level 5 (Breast Centre)
  
  21 Level 5 (Skin and Plastic Surgery)
  
  22 Level 5 (NCCS Oncology @ SKH)
  
  23 Level 5 (Haematology)
  
  24 Level 5 (Neuroscience)
  
  25 Level 5 (Mind & Body Integration)
  
  26 Level 6 (General/Hepatobiliary Surgery)
  
  27 Level 6 (General/Upper GI Surgery)
  
  28 Level 6 (Gastroenterology & Hepatology)
  
  29 Level 6 (General/Colorectal Surgery)
  
  30 Level 6 (Ear, Nose, Throat (ENT))
  
  31 Level 6 (Head & Neck Surgery)
  
  32 Level 6 (Sleep Medicine)
  
  33 Level 7 (Urology)
  
  34 Level 7 (Diabetes and Endocrinology)
  
  35 Level 7 (General/Bariatric Surgery)
  
  36 Level 7 (Renal Medicine)
  
  37 Level 7 (Geriatric Medicine)
  
  38 Level 7 (Mind & Body Integration)
  
  39 Level 7 (Paediatrics)
  
  40 Level 8 (Acupuncture)
  
  41 Level 8 (Pain Management)
- 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 After your registration and preliminary tests (if any) were completed, how long did you wait before seeing the doctor?
  
  1 Less than 30 minutes
  
  2 30 minutes to 1 hour
  
  3 1 hour to 2 hours
  
  4 More than 2 hours
- c Did you get your next appointment close to what was advised by your doctor or nurse?
  
  1 Yes, definitely
  
  2 Yes, mostly
  
  3 Yes, somewhat
  
  4 No
- d 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
- e After you were referred to the specialist, was the waiting time for your appointment date reasonable?
  
  1 Very reasonable
  
  2 Somewhat reasonable
  
  3 Somewhat unreasonable
  
  4 Very unreasonable
- 5 Environment & Facilities
- a How often were areas around you clean?
  
  1 Always
  
  2 Usually
  
  3 Sometimes
  
  4 Never
- b How often was the toilet kept 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 SKH to your friends and family?
  
  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 new medicine, the pharmacy staff explained clearly what the new 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
- h After seeing the doctor, was the waiting time to get medication from the pharmacy reasonable?
  
  1 Very reasonable
  
  2 Somewhat reasonable
  
  3 Somewhat unreasonable
  
  4 Very unreasonable
- i What would be the longest reasonable waiting time to get medication from the pharmacy after seeing the doctor? (in mins)
  
  OK
  
  press ENTER
- 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
- b How often was the toilet kept 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 SKH to your friends and family?
  
  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 new 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 and the purpose for them.
  
  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 SKH to your friends and family?
  
  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
- 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 cope or manage your condition at home?
  
  1 Yes, definitely
  
  2 Yes, mostly
  
  3 Yes, somewhat
  
  4 No
- 3 Radiology (Answer if applicable)
- a How often did the radiographer(s) 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(s) who performed your image procedure listen carefully to you?
  
  1 Always
  
  2 Usually
  
  3 Sometimes
  
  4 Never
- c How often did the radiographer(s) 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(s) 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(s) who performed your image procedure?
  
  1 Always
  
  2 Usually
  
  3 Sometimes
  
  4 Never
- 4 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
- c How often did the medical social worker(s) treat you with courtesy and respect?
  
  1 Always
  
  2 Usually
  
  3 Sometimes
  
  4 Never
- d How often did the medical social worker(s) listen carefully to you?
  
  1 Always
  
  2 Usually
  
  3 Sometimes
  
  4 Never
- e How often did the medical social worker(s) explain things in a way you could understand?
  
  1 Always
  
  2 Usually
  
  3 Sometimes
  
  4 Never
- f How often did the medical social worker(s) treat you with kindness and compassion?
  
  1 Always
  
  2 Usually
  
  3 Sometimes
  
  4 Never
- g How often did you have confidence and trust in the medical social worker(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 new medicine, the pharmacy staff explained clearly what the new 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
- h After seeing the doctor, was the waiting time to get medication from the pharmacy reasonable?
  
  1 Very reasonable
  
  2 Somewhat reasonable
  
  3 Somewhat unreasonable
  
  4 Very unreasonable
- i What would be the longest reasonable waiting time to get medication from the pharmacy after seeing the doctor? (in mins)
  
  OK
  
  press ENTER
- 6 Environment & Facilities
- a How often did areas around you appear clean?
  
  1 Always
  
  2 Usually
  
  3 Sometimes
  
  4 Never
- b How often was the toilet kept clean?
  
  1 Always
  
  2 Usually
  
  3 Sometimes
  
  4 Never
- 7 Overall Rating of the Hospital
- a Would you recommend SKH to your friends and family?
  
  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
- 8 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
- 9 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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