Feedback Form
If you would like to help us improve next year’s report, please complete the following feedback form by clicking on the most appropriate response. You can also type comments. You must provide answers to questions one and two to be able to submit the form. The information that you provide will be anonymous.

1. I am
  Southern Health Patient/Consumer Southern Health Staff Member
Community Member Healthcare Professional
Other, please specify:
 
2. I live in
Please provide your 'Suburb':
 
3. How did you see a copy of the report?
Hospital Waiting Room
GP's Rooms
Internet
 
4. Overall, what did you think of the report?
Poor Good
Fair Excellent
Comments
 
5. What did you think of the layout and presentation of the report?
Poor Good
Fair Excellent
Comments
 
6. Did you find the report easy to read?
Yes No
Comments
 
7. Has the report made you more aware of the quality of services provided by Southern Health?
Yes No
Comments
 
8. What was the most interesting part of the report?
 
9. What was the least interesting part of the report?
 
10. Do you have any other comments? If so, please note them here…