Feedback Form - St Luke's Hospice

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How would you rate our care?

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St Luke’s Hospice values the feedback of all our patients, families and supporters. Please leave feedback about any areas of our work on the form below.

Which of our services are you providing feedback for?
- Inpatient Unit
- Wellbeing Service
- Hospice@Home
- Shops
- Events
How would you rate our care?
Untitled Survey Field
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Are you a…
- Patient
- Family member
- Friend

Please indicate your agreement with the following statements:

What was good about your experience?
Was there anything that could have improved your experience?
Your feedback can be anonymous, but if you would like to leave your name and contact details, we will acknowledge your comment and can let you know our response to your suggestion or comments.
Name
First Last
Email
Phone
Keep in touch
I would like to be added to the mailing list
We would like to stay in touch and keep you up to date with the work that we are doing, tell our supporters about the amazing difference that they make, and about future events, fundraising activity and other ways of getting involved.

You can visit www.stlukes-hospice.org/yourdata to find out more about how we use your information.

Please tick here if you would like to be added to our mailing list and ensure you have enclosed your contact details above.
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Name*
First Last
Email*
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Name
This field is for validation purposes and should be left unchanged.

By giving us your email address, you’re giving us permission to email you about our work

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Strongly agree

Strongly disagree

Don’t know or not applicable

I was treated with dignity, respect, kindness and caring

I felt involved in decisions made about my care

I had confidence and trust in the staff looking after me

I was satisfied with the support I received