Silent Hospital Patient Survey

Where do you live?

Mandatory

Mid Cornwall North Cornwall North East Cornwall South East Cornwall West Cornwall Isles of Scilly Prefer not to say Other

Mandatory

How old are you?

Mandatory

<20 21-25 26-30 31-35 36+

Date of Arrival on Wheal Rose Ward / Day Assessment / Triage

Mandatory

How long did you stay?

Mandatory

Up to 3 hrs 3 hrs to 6hrs 6 hrs to 12 hrs 12 hrs to 24 hrs 2 nights 3 nights Other

Mandatory

More than 3 nights (please state)

If you can remember, which bay or room were you in?

Mandatory

Triage area Day Assessment Unit Wheal Rose Cannot remember

On a scale of 1 to 10, how calm and secure did you feel when visiting / staying on Wheal Rose Ward, Day Assessment Unit or Triage?

1 being not calm or secure at all, 5 being quite calm and secure, 10 being very calm and secure

Mandatory

Were you able to sleep during your stay?

Mandatory

Yes No

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