PiCC Service – Patient Satisfaction Survey We would like to know how our PiCC service is doing - please complete the form below. How did we do? Note: Questions marked by * are mandatory Yes No Not Applicable *This is a mandatory field. Do you feel you were sufficiently involved in the decision to refer you to the PiCC service? *This is a mandatory field. Was your PiCC nurse professional and friendly? *This is a mandatory field. Was the information you received appropriate and clear? *This is a mandatory field. Were you given the opportunity to ask questions prior to your procedure? *This is a mandatory field. Was your line inserted in a private and clean clinical area? *This is a mandatory field. Did you feel empowered to challenge any mishandling of your line on the ward? *This is a mandatory field. Do you feel the PiCC nurse carried out your post-insertion visit in a timely manner? *This is a mandatory field. Were you given the contact information for the PiCC service? *This is a mandatory field. Do you feel like you can contact the service for further information or support? *This is a mandatory field. Are you satisfied that the line achieved the desired outcome? *This is a mandatory field. Would you consider having a line again, if needed? *This is a mandatory field. Overall, how would you rate the service? Excellent Good Poor Very Poor *This is a mandatory field. Comments