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Questionnaire template

Surgical Consent Experience

Measures how well surgical patients felt informed and how clear they found the consent form, with suggestions for improvement.

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Healthcare · Patient consent. All Healthcare templates

Questions in this template

Information Before Your Surgery

  1. Thank you for taking part. We would like to learn how you experienced the consent process before your operation, so that we can make it better for future patients.

  2. Before your operation, were you given enough information about the procedure?

    Choose one:

    • Yes
    • No
    • Not sure

  3. Which information was most useful to you when deciding to go ahead with the operation?

    Open answer

  4. Did you have any of these difficulties while getting information about your operation?

    Choose any that apply:

    • Medical terms were hard to follow
    • There was not enough time to talk it through
    • It was hard to reach or speak with the surgeon
    • None of these

  5. Please tell us more about the difficulties you had.

    Condition: Only when at least one difficulty was selected

    Open answer

The Consent Form

  1. How clear was each of these parts of the consent form you signed?

    • Why the procedure was being done
    • Possible risks and side effects
    • Expected benefits

    For each row: choose one:

    • Extremely clear
    • Clear
    • Somewhat clear
    • Not clear at all

  2. Overall, how clear was the consent form?

    Choose one:

    • Very unclear
    • Unclear
    • Neither clear nor unclear
    • Clear
    • Very clear

Improving the Consent Process

  1. Is there anything else about your consent experience that would help us improve?

    Open answer

  2. Would you suggest any changes to the consent form or to how consent is obtained?

    Choose one:

    • Yes
    • No
    • Not sure

  3. What changes would you suggest?

    Condition: Only when changes were suggested

    Open answer