0%

In-Patient Survey Form

Your feedback is central to continued improvement of our services so we can offer high quality of care. We are collecting and using data in accordance with the LOROS privacy notice. Please contact the LOROS Information Commissioner at dataprotection@loros.co.uk or 0116 231 3771 if you have any concerns. Click START to continue.

Section 1

Your care at LOROS

We will not ask you to identify yourself in the survey. To maintain the privacy of our staff we request you DO NOT IDENTIFY them by name. We want you to please rate your satisfaction/score based on your experience with us. Click 'NEXT' to start answering the survey.

Extremely satisfied
Very satisfied
Somewhat satisfied
Not very satisfied
Not at all satisfied
Extremely satisfied
Very satisfied
Somewhat satisfied
Not very satisfied
Not at all satisfied
Extremely satisfied
Very satisfied
Somewhat satisfied
Not very satisfied
Not at all satisfied
Extremely satisfied
Very satisfied
Somewhat satisfied
Not very satisfied
Not at all satisfied
Extremely satisfied
Very satisfied
Somewhat satisfied
Not very satisfied
Not at all satisfied
Extremely satisfied
Very satisfied
Somewhat satisfied
Not very satisfied
Not at all satisfied
NOTE: Please do not identify yourself or our staff

In-Patient Survey Form

Section 2

LOROS Environment and You

Extremely satisfied
Very satisfied
Somewhat satisfied
Not very satisfied
Not at all satisfied
Extremely satisfied
Very satisfied
Somewhat satisfied
Not very satisfied
Not at all satisfied
Extremely satisfied
Very satisfied
Somewhat satisfied
Not very satisfied
Not at all satisfied
Extremely satisfied
Very satisfied
Somewhat satisfied
Not very satisfied
Not at all satisfied
NOTE: Please do not identify yourself or our staff

In-Patient Survey Form

Section 3

LOROS Staff and You

Extremely satisfied
Very satisfied
Somewhat satisfied
Not very satisfied
Not at all satisfied
Extremely satisfied
Very satisfied
Somewhat satisfied
Not very satisfied
Not at all satisfied
Extremely satisfied
Very satisfied
Somewhat satisfied
Not very satisfied
Not at all satisfied
Extremely satisfied
Very satisfied
Somewhat satisfied
Not very satisfied
Not at all satisfied
Extremely satisfied
Very satisfied
Somewhat satisfied
Not very satisfied
Not at all satisfied
Extremely satisfied
Very satisfied
Somewhat satisfied
Not very satisfied
Not at all satisfied
NOTE: Please do not identify yourself or our staff

In-Patient Survey Form

Section 4

Finally, your thoughts and rating

Extremely likely
Somewhat likely
Not very likely
Not at all likely
Extremely likely
Somewhat likely
Not very likely
Not at all likely

Confirmation

Do you want to submit the form and finish the survey?