Questionnaire Request Form

PKB has a comprehensive library of questionnaire templates that have already been created and are being used by teams with their patients, however, if you would like to create a questionnaire for your team to use with your patients, PKB will support you with the creation of two questionnaire templates, with two additional updates per questionnaire.

To request the creation of a questionnaire template, please complete the Questionnaire Request Form

and submit it for review. Your Success project manager will be in touch within five working days.

To request an advance questionnaire template, ask your Success PM, and they will create this template for the team.

PKB Questionnaires Templates:

• Patient activation measures (PAM) template: example of how PAM can be done through PKB

• Dermatology questionnaire templates: Quality of Life and Psoriasis Epidemiology Screening Tools

• Mental Health questionnaire templates: examples of questionnaires used by mental health teams using PKB

• Pre-Clinic Covid Questionnaire template: for every patient in the Org to complete before appointments or surgery

• After Surgery Questionnaire template: for preparation for transplant follow up appointment

• PREOM questionnaire template: how to do Patient Reported Experience and Outcome Measure in PKB