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* 1. Who did you see today?

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* 2. Please select the most appropriate responses for the statements below

  Strongly Agree Agree Neither agree nor disagree Disagree Strongly disagree
The staff are easy to talk to and encourage me to ask questions.
Staff listen to me when I speak.
The staff always explain things in a way that is easy to understand.
I know how to make a suggestion or complaint.
I feel that I am involved to the extent that I want to be in decisions about my care.
The programs and service have helped me improve my health and well-being
My health care provider always spends enough time with me

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* 3. Please tell us about our Telephone Based Services:

  Helpful Not Helpful Don't Know
Reception
Nursing Assistance
After Hours Doctor on call

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* 4. The last time you needed to see a health provider, how long did it take for you to receive an appointment?

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* 5. Overall, how would you rate the care and services you received at Country Roads Community Health Centre?

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* 6. In what year were you born?

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* 7. Are you

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* 8. Which services or programs offered by Country Roads have you used within the past year?

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* 9. Please share with us any additional comments.

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