Formic Online Forms - [Endoscopy Unit Patient Survey 2021

Endoscopy Unit
Patient Satisfaction Questionnaire 2021

In order to improve and review our service, we are inviting patients to complete a satisfaction questionnaire. If you have received sedation for your procedure, please do not complete this form for 24 hours after your procedure because you may not be able to recollect details.

Please note that any responses that you make will be anonymous, and will not affect your future care, and anything that you say will be treated confidentially.

Q1 What procedure did you have?

Gastroscopy:
An examination of the inside of the stomach using a
thin flexible tube passed through the mouth and
oesophagus

Colonoscopy:
An examination of the inside of the colon (bowel)
using a thin, flexible tube inserted into the rectum

Flexible sigmoidoscopy:
Inspection of the lower colon (bowel) using a thin,
flexible tube inserted into the rectum

ERCP:
A procedure to x-ray the bile and pancreatic ducts.
In this procedure a thin, flexible tube is passed
through the mouth and down into the first part of
the small intestine (duodenum)

Unsure or don't know

The Endoscopy Booking Service

Please comment
if you wish:

Q2 Was the appointment sent to you convenient?

Yes

No

I can't remember

Q3 If the appointment was not convenient, did you rearrange it?

Yes

No

I can't remember

Q4 Did you have any difficulties making contact with the Booking Team when required?

Yes

No

I didn't contact the Booking Team

I can't remember

Q6 How helpful were the Booking Team?

Very helpful

Helpful

Unhelpful

Very unhelpful

I can't remember

I didn't contact the
Booking Team

Q5 How did you contact the Booking Team?

Telephone

Email

Attended the Unit

I can't remember

Q7 How did you find the reception booking-in experience?

Poor

Fair

Good

Excellent

I can't remember

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