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ACES Patient Satisfaction Survey

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
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Clinic Location(Required)
Date of Attendance(Required)
MM slash DD slash YYYY
In regards to your journey (please tick):(Required)
Excellent Good Fair Poor Very Poor Does not apply
Directions to the ACES clinic
Locating the ACES clinic
Parking
In regards to organising your appointment (please tick):(Required)
Excellent Good Fair Poor Very Poor Does not apply
Did you understand the reason for your appointment
Helpfulness of staff on the telephone
ACES Opening Hours
From the point of being referred to ACES, how long was your wait until your appointment (please tick):(Required)
- Less than 2 weeks
- 2-4 weeks
- 4-6 weeks
- 6-12 weeks
- Longer than 12 weeks
How long were you in the ACES clinic for on the day of your pre-assessment / glaucoma / general clinic consultation. (please tick):(Required)
- Less than 1 hour
- 1-2 hours
- 2-3 hours
- More than 3 hours
How long were you in the ACES clinic for on the day of your surgery? (only applicable to cataract surgery patients – please tick):
- Less than 1 hour
- 1-2 hours
- 2-3 hours
- More than 3 hours
How well did we greet you upon arrival (please tick):(Required)
Excellent Good Fair Poor Very Poor Does not apply
Helpfulness of receptionist
Friendliness of receptionist
Quality of waiting area
Cleanliness of waiting area
In regards to accessibility (please tick):(Required)
Excellent Good Fair Poor Very Poor Does not apply
How easy was it to enter and move around our clinic
Were you comfortable during your stay (chairs)

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

	Excellent	Good	Fair	Poor	Very Poor	Does not apply
Quality of consultation room
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
The length of your consultation
The overall quality of your consultation

In regards to your surgery (only applicable to cataract surgery patients – please tick):(Required)

	Excellent	Good	Fair	Poor	Very Poor	Does not apply
Information provided before surgery
Care from Health Care Assistant before surgery
How well any questions you had were answered on the day of surgery
Care from theatre staff during surgery
Quality of theatre facilities
Cleanliness of theatre facilities
Care from Health Care Assistant after surgery
Post-op information provided

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
Email
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ACES Patient Satisfaction Survey

ACES Patient Satisfaction Survey

Next Steps: Install the Survey Add-On