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Please note: questions indicated by * are mandatory fields
Your Name
Your Email
Your Mobile
Which secretary served you? * ---select---JacintaRoseAliceJessicaJesseLaffyUnsureNot ApplicableWould rather not say
Which secretary served you? *
How would you rate the overall quality of your secretarial support? * ---select---excellentgoodaveragepoorbadunsurenot applicableWould rather not say
How would you rate the overall quality of your secretarial support? *
Have you recently had an consultation? * ---select---YesNoNot Applicable
Have you recently had an consultation? *
Who was your treating surgeon? * ---select---Dr Barry McCabeDr Maroof KhanDr Sebastian RodriguesUnsureNot ApplicableWould rather not say
Who was your treating surgeon? *
How would you rate the overall quality of the consultation? * ---select---excellentgoodaveragepoorbadunsurenot applicableWould rather not say
How would you rate the overall quality of the consultation? *
How well were your concerns listened to? * ---select---excellentgoodaveragepoorbadunsurenot applicableWould rather not say
How well were your concerns listened to? *
How was your consultation conducted? * ---select---Face to faceTelehealthNot ApplicableWould rather not say
How was your consultation conducted? *
Have you recently had an endoscopy procedure? * ---select---YesNo
Have you recently had an endoscopy procedure? *
Which hospital did you have this procedure? ---select---North Shore Specialist Day HospitalSt George Private HospitalWestmead Private HospitalWaratah Private HospitalHolroyd Private HospitalOther HospitalNone of the aboveNot ApplicableWould rather not say
Which hospital did you have this procedure?
How would you rate the preparation of your admission ---select---excellentgoodaveragepoorbadunsurenot applicableWould rather not say
How would you rate the care of the hodpital staff during your admission? ---select---excellentgoodaveragepoorbadunsurenot applicableWould rather not say
Were you adequately prepared and advised on the admission process, bowel preparation and fasting required prior to your procedure? ---select---very well preparedadequately preparednot quite prepared enoughvery poorly preparedunsureNot applicableWould rather not say
How well were the endoscopy findings discussed with you immediately after your procedure by your treating specialist? ---select---excellentgoodaveragepoorbadunsurenot applicableWould rather not say
How would you rate the overall experience? ---select---excellentgoodaveragepoorbadunsurenot applicableWould rather not say
What needs to be improved? (please type below)?
Do you have any further feedback (please type below)?
Would you like to receive a phone call? ---select---YesNo
