Feedback Form for Minor Procedures

  • Personal Information
  • The Procedure
  • After the Procedure

Your personal information

Title

Full Name

Date of Birth

During and Before the procedure

Did you understand how the procedure would be done?

Did you understand why we were doing the procedure?

Were you told about possible complications of the procedure?

How much information about your condition or treatment was given to you?

More information

The results of the procedure

Were you given a leaflet about your procedure or the after effects?

Were you happy with the result of your procedure?

On a scale of 1-5 how much has your pain improved (1 being not at all 5 being completely)

On a scale of 1-5 how would you rate your experience of using this service overall

I agree to being contacted via the details given above. I agree to the Privacy Policy.

To view our privacy policy, click here