Meditote User Survey
Name
First Name
Last Name
Age
0 - 15 years
16 - 29 years
30 - 49 years
50 - 69 years
70+ years
Type of establishment
Hospital
Aged Care Facility/ Respite
Personal Home Use
Other
Mobility
Mobile WITHOUT assistance
Mobile with assistance or aid
Not mobile or strict rest in bed
Are you able to reach your drawers from your bed safely?
Yes
No
Not Applicable
Did you use all the pockets in your Meditote?
Yes
No
If your last answer was 'no' we appreciate your feedback on the use of the pockets
What have you stored in your Meditote?
Water bottle and snacks
Purse, wallet or cash
Phone and chargers
Electronic devices and headphones
Reading glasses
Magazines or books
Notebook and pen
Items and clothing
Slippers, socks TED stockings
Eye mask and ear plugs
Toiletries
Sick bag and toilet paper
Nurse call, bed or TV device
Daily living aids or exercise equipment
Anti-slip socks or TED stockings
Other
Do you have any suggestions for alterations to the Meditote ?
Please rate your Meditote between 1 - 10
1 = Rarely used & 10 = Extremely useful
Please leave a comment on your score above
Example: Why do you love the Meditote
Would you recommend the Meditote to others?
Yes
No
Would you consider purchasing a Meditote if it wasn't supplied?
Yes
No
If you answered 'No' please leave a comment below
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