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    Were you hospitalized?

    How would you rate the environment in the hospital ward :
    Hygiene /e.g. 1= "poor", 5= "very good"/

    Facilities for parents on the ward (select all that apply)


    Medical equipment (choose all that apply):

    Treatment environment in the hospital (select all that are true):



    Staff:

    How would you rate the overall attitude of the doctors /for example 1= "bad", 5= "very good"/

    How would you rate the overall attitude of the nurses /for example 1= “poor”, 5= “very good”/

    Communication with the patient:

    How would you rate the doctors' communication with you overall /for example 1= "bad", 5= "very good"/

    How would you rate the doctors' overall communication with the child patient /for example 1= "bad", 5= "very good"/

    Was the child's condition explained to you?

    Were the child's treatment options discussed with you?

    Was the child's condition explained to the child himself?

    Was there communication with the child before the procedures were performed during the hospital stay?

    Psychological support:

    Is there a psychologist in the hospital that you can turn to if needed?

    Contact information:



    Complete if you are completing the form on behalf of someone else.



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