ACES Patient Satisfaction Survey – Cataract Surgery

ACES Patient Satisfaction Survey – Cataract Surgery

Next Steps: Install the Survey Add-On

ACES Patient Satisfaction Survey – Cataract Surgery

Home » ACES Patient Satisfaction Survey – Cataract Surgery

As part of our commitment to continuously improving the quality of care we provide, we are asking you to complete a Patient Satisfaction Survey. This questionnaire is designed to capture your experience and insights about the care you have received during your journey with ACES.

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Next Steps: Install the Survey Add-On
This form requires the Gravity Forms Survey Add-On. Important: Delete this tip before you publish the form.
Clinic Location(Required)
Date of Attendance(Required)
MM slash DD slash YYYY
In regards to attending the ACES clinic or hospital, please confirm how you found the directions to and accessibility of the facility (please tick):(Required)
Excellent Good Fair Poor Very Poor Does not apply
In regards to organising your initial appointment can you rate the helpfulness of the staff and the speed of response of you receiving this appointment (please tick):(Required)
Excellent Good Fair Poor Very Poor Does not apply
How long were you in the ACES clinic for on the day of your pre-assessment consultation. (please tick):(Required)
- Less than 1 hour
- 1-2 hours
- 2-3 hours
- More than 3 hours

In regards to your clinician-led pre-assessment consultation (please tick):(Required)

	Excellent	Good	Fair	Poor	Very Poor	Does not apply
How well they listened to you describing any symptoms or problems
How well they explained any treatments/tests/problems
How well they answered any questions you had
How well they put you at ease
How much you were involved in decisions about your care
Information video you observed
The overall quality of your consultation

How long were you in the ACES clinic for on the day of your cataract surgery? (please tick):(Required)
- Less than 1 hour
- 1-2 hours
- 2-3 hours
- More than 3 hours
On the day of your procedure how would you rate the welcome you received from staff and the cleanliness of the waiting area at the ACES clinic / hospital? (please tick):(Required)
Excellent Good Fair Poor Very Poor Does not apply

In regards to your surgery (please tick):(Required)

It will help us to understand your answers if you could tell us a little about yourself – age (please tick):(Required)
- 18-25
- 25-35
- 35-45
- 45-55
- 55-65
It will help us to understand your answers if you could tell us a little about yourself – age (please tick):(Required)
- Male
- Female
- Prefer not to say
Is there anything particularly good about the health care you received from ACES?(Required)
Is there anything you think we could change or improve?(Required)
Do you have any other comments?
Please rate your overall experience (please tick one of the options below):(Required)
Excellent Good Fair Poor Very Poor Does not apply
How likely are you to recommend ACES vision correction surgery to your friends and family?(Required)
10 9 8 7 6 5 4 3 2 1 0
Name
This field is for validation purposes and should be left unchanged.

Does not apply

Information provided before surgery

Care from Health Care Assistant before and after surgery

Care from the treating Surgeon

How well any questions you had were answered on the day of surgery

Care from theatre staff during surgery