PALS - Questions, Queries and Concerns
Go To Survey
Your Details
*
Your full name
*
*
*
Your contact details
*
*
*
Is your enquiry about your care, or someone else's care?
*
--- Select Option ---
I am the Patient
Someone else is the patient
*
*
Patient Details
*
Patient's full name
*
*
*
The Patient's contact details
*
*
*
Patient's date of birth
*
*
*
Patient's NHS or hospital number
* Input digits (0 - 9)
*
What is your relationship to the Patient?
*
--- Select Option ---
I am the Patient
Spouse / Partner
Parent
Child
Carer
Other
*
*
Why are you contacting the Patient and Advice Liaison Service (PALS)?
*
Date of admission/event (if known)
*
Which hospital/ward/department/speciality does it relate to (if known)?
*
Details of why you are contacting PALS - Please give a summary of events, details of your experience or your enquiry, which has led to you to contact PALS. Please include dates, times, locations and names where known. This will help us identify how best we can assist you
*
*
*
Have you already contacted the ward/relevant team about your concerns/enquiry?
*
--- Select Option ---
Yes
No
I tried and they told me to contact PALS
*
*
Please provide details of who you spoke to, and the outcome of that discussion
*
*
*
Please provide details of who you spoke to, and the outcome of that discussion
*
*
*
If you’re unhappy with a service at one of our hospitals, it’s often worthwhile discussing your concerns early on with someone on the ward, or in the team providing your care, as they may be able to sort the issue out quickly. Misunderstandings can easily happen and sometimes can just as easily be put right. If you would like to try speaking directly with the ward/team, please call the number provided by them, or call our Switchboard who can assist you.
*
What outcome are you hoping for as a result of contacting PALS?
*
*
*
Any other information you'd like our PALS Officers to know
*
Submit
Back to start
Thank you for your feedback
Next Survey