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    Were you hospitalized?

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    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?

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

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    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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