Feedback

Which city would you like to submit the feedback for?

Which hospital would you like to provide feedback on?

How long did it take you from the time you arrived at the hospital to seeing a specialist?

In which department were you accepted?

Were you hospitalized?
YesNo

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How long were you hospitalized for?

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How would you rate the environment in the hospital ward :
Hygiene /e.g. 1= "poor", 5= "very good"/
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Facilities for parents on the ward (select all that apply)
There are beds for the parents
There is a refrigerator for parents and patients to use
There is a bathroom for the parents

Medical equipment (choose all that apply):
Children's beds are secured
The available equipment helps the procedures of child patients to be performed stress-free

Treatment environment in the hospital (select all that are true):
Children's rooms are comfortable and spacious
There is enough daylight in the rooms
There are drawings on the walls in the ward
The hospital has a designated area where children can spend time in games and activities

Staff:

How would you rate the overall attitude of the doctors /for example 1= "bad", 5= "very good"/
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How would you rate the overall attitude of the nurses /for example 1= “poor”, 5= “very good”/
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Would you nominate a doctor/nurse to be a "Firefly Doctor" or "Firefly Nurse" Doctor Svetulka and Sister Svetula are our ambassadors of the idea of placing the child patient at the center of the healing process. They are the embodiment of the doctor, putting the needs of the child before everything else. Attentive, understanding, empathetic and concerned. One that informs both the child and their parents about the treatment process with professionalism and empathy.

Communication with the patient:

How would you rate the doctors' communication with you overall /for example 1= "bad", 5= "very good"/
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How would you rate the doctors' overall communication with the child patient /for example 1= "bad", 5= "very good"/
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Was the child's condition explained to you?
YesNo

Were the child's treatment options discussed with you?
YesNo

Was the child's condition explained to the child himself?
YesNo
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If yes - please describe who did it and how?

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Was there communication with the child before the procedures were performed during the hospital stay?
YesNo
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If yes - please describe who did it and how?

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Psychological support:

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

Is there anything else you would like to share with us?

What would you like to change after filling out this feedback form?

Contact information:

Name:
Telephone:
Email:

Complete if you are completing the form on behalf of someone else.
Patient Name:
Patient's date of birth:
Your relationship with the patient:
CONSENT TO PERSONAL DATA

Sofia,
3 Hristo Belchev Street
+359 896 712 591
team@zadobroto.com

Foundation For Good

National cause: children's health

#foundationHeroes fund

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