Weekly Patient Check-In - Rehabilitation Centre in Bloemfontein

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Rehab Centre Bloemfontein
Our Programme
Our Values
About Us
Blog

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About Us
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MeziTouch Rehab: Weekly Patient Check-In

Your feedback helps us improve your stay and treatment at MeziTouch. Please answer based on your experience during the last week.

You may be honest about concerns. If you would like management to speak to you privately, you can request this at the end.

079 175 4046

079 175 4046

info@mezitouch.co.za

Weekly Check-in

SECTION 1: FOOD

Overall, how would you rate the food this week? *

Excellent

Good

Okay

Needs improvement

Poor

How would you rate the following?

Taste *

Excellent

Good

Okay

Needs Improvement

Poor

Portion sizes *

Excellent

Good

Okay

Needs Improvement

Poor

Variety *

Excellent

Good

Okay

Needs Improvement

Poor

Meal presentation *

Excellent

Good

Okay

Needs Improvement

Poor

Did you experience a problem with any meal this week? *

Please tell us briefly what the problem was:

Is there anything you would like to suggest about the food? (Optional)

SECTION 2: ACCOMMODATION

Overall, how would you rate the accommodation this week? *

Excellent

Good

Okay

Needs improvement

Poor

How would you rate the following?

Bedroom *

Excellent

Good

Okay

Needs Improvement

Poor

Bathrooms *

Excellent

Good

Okay

Needs Improvement

Poor

Common areas *

Excellent

Good

Okay

Needs Improvement

Poor

Cleanliness *

Excellent

Good

Okay

Needs Improvement

Poor

Comfort *

Excellent

Good

Okay

Needs Improvement

Poor

Is anything broken, damaged, dirty or needing attention? *

What needs attention?

SECTION 3: GROUP SESSIONS

Overall, how helpful were the group sessions this week? *

Extremely helpful

Very helpful

Helpful

Not very helpful

Not helpful

Did you feel comfortable participating in the groups? *

Always

Most of the time

Sometimes

Rarely

Never

Which group or topic helped you the most this week? *

What would you like us to talk about in future groups? (Optional)

SECTION 4: INDIVIDUAL SESSIONS

How helpful were your individual sessions this week? *

Extremely helpful

Very helpful

Helpful

Not very helpful

Not helpful

I did not have an individual session

Did you feel listened to and understood? *

Yes, definitely

Mostly

Sometimes

Not really

No

Is there anything you would like more help with in your individual sessions?

SECTION 5: YOUR EXPERIENCE THIS WEEK

Overall, how would you rate your week at MeziTouch? *

1 Star 2 Stars 3 Stars 4 Stars 5 Stars

Did you feel safe, respected and treated with dignity this week? *

Yes, always

Most of the time

Sometimes

Rarely

No

Would you like to tell us what happened?

SECTION 6: MANAGEMENT & CONCERNS

Is there anything you want management to know about? *

Please tell us what you would like management to know:

Would you like someone from management to speak to you privately? *

Please enter your name:

Is there anything else you would like to tell us, suggest or ask?

If you are human, leave this field blank.

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