Feedback

St Nicholas Hospice Care aims to provide the best possible care for patients, families and carers at a difficult time in their lives. Through listening to people we will be able to improve the services we offer. By completing this feedback form you will be helping us understand the needs of the people we serve. Thank you.

	Are you? *	Male Female
	Your connection with the Hospice *
	Patient Relative Friend Professional Participant on education session Other
	If other please specify
	Your age
	Under 16 17 - 24 25 - 40 41 - 50 51 - 64 65 - 74 75+
	Which Hospice department or area are you giving feedback on? *
	In Patient Unit Day Hospice Macmillan Nurses Complementary Therapies Medical Team Physiotherapy Occupational Therapy Chaplaincy Family Support Bereavment Nicky's Way Time 4 You Positive Living Carer's Group Fatigue Group Fundraising and Marketing Shops and Retail Lottery Education Other
	If other please specify
	What was most helpful?

	What was least helpful?

	What could we do to improve?

	If you would like a reply to your feedback please confirm your email address:

	I am happy for my comments to be used for education or publicity *
	Yes No