HOSPICE PATIENT REVIEW

Hospice - patient review

This review form is for patients who are currently on our hospice program, or past hospice patients who were discharged. If you are a family member wanting to give a review please select the "Hospice - caregiver review" form.

How would you rate your overall care by your hospice team?*
Please let us know how hospice care has been beneficial to you.*
Is hospice care allowing you to have a better quality of life?
- Yes
- No
If you were a hospice patient that was discharged, DID hospice care allow you to have a better quality of life?
What has been the most beneficial part of being under hospice care?*
What would you say to someone who is considering hospice care but unsure if it is time yet?*
Is there anything related to your care that we could be doing better for you? If so, please describe below.
We are working to tell our story more, so that those who need Hospice Care know we are here for them. Would you be willing to help by talking with Brittany and telling your story and experience with Hospice care?*
- Yes
- No
If you answered yes to the previous question, please enter your phone number below so Brittany knows how to reach out to you.
Name*
First Last

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