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Concentric digital consent feedback

Example template

This is an example template and can be modified to your own questions should you wish.
Concentric is the digital consent application being used at , and aims to support you in making decisions about treatment. To find out more about Concentric, you can visit the Concentric website.
You have received this survey link from your clinician because you have given your consent to treatment digitally, either in person with your clinician or remotely. Responses are used by the organisation and clinical teams to continuously improve the quality and experience of care.
Your responses will not impact your care and you should not expect a response based on feedback provided. Please do not use this survey to ask questions about your care – these should be directed to your healthcare organisation directly.

How satisfied were you with the Concentric digital consent process?

How satisfied were you with the Concentric digital consent process?
Very dissatisfiedVery satisfied

What is the one thing that could be improved on?

This could be an improvement to the consent process or an improvement to the Concentric application.

We conduct user research to help continually improve services for you and other patients. Would you be willing to be contacted by Concentric Health and/or your healthcare organisation regarding participation in such research?

We conduct user research to help continually improve services for you and other patients. Would you be willing to be contacted by Concentric Health and/or your healthcare organisation regarding participation in such research?
A
B