Bereavement Feedback
Can you tell us what was memorable for you in the care you/your loved one received?
Are there any particular members of staff/departments you want to give a special mention to?
Please let us know if you have any other feedback, including how we could improve our service:
With this in mind, could you tell us:
Yes
No
Not Applicable
Did you feel you and your loved one were looked after with compassion and dignity?
Were the staff professional?
Did the staff make time for you?
Did you feel your perspective was valued?
Were you made to feel welcome?
Were you satisfied with the level of communication and information shared?
Did you feel you could ask questions and/or raise concerns?
How would you rate your Dove House Hospice experience:
Outstanding
1
2
3
4
Poor
5
1 is Outstanding, 5 is Poor
Thank you for taking the time to complete this questionnaire and helping us to improve care for patients and their families. If you would like to be contacted to follow up on your comments, please complete your details below:
Your details:
First Name
Last Name
Contact Number
Email
example@example.com
Patients name:
First Name
Last Name
Submit
Should be Empty: