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Dr. Heather K. Spence Laschinger
PSNCQQ - Request Form
Please provide ALL the following information.
*Note: Incomplete submissions will not be processed.

I request permission to copy the Patient Satisfaction With Nursing Care Quality Questionnaire as developed by Dr. Heather K. Spence Laschinger et al (2005). Upon completion of the research, I will provide Dr. Laschinger with a brief summary of the results, including information related to the use of the PSNCQQ used in my study.

* Date:      

* Name:    

* Title of Study:       

* University/Organization: 

* Address:

* Phone:    

* E-mail:    

* Description of Study, including population: 

Permission is hereby granted to copy and use the Patient Satisfaction with Nursing Care Quality Questionnaire

Date:

Signature:

Dr. Heather K. Spence Laschinger
Distinguished University Professor
Associate Director Nursing Research

Aurthur Labatt Family School of Nursing
Faculty of Health Sciences
The University of Western Ontario
London, Ontario, Canada N6A 5C1
Phone: (519) 661-4065
Fax: (519) 661-3410
E-mail: hkl@uwo.ca

Thank you for your interest in my work. The questionnaire as well as a signed copy of this request form providing permission to use the questionnaire will be sent to you at the e-mail address you provided.