NEW Outreach Patient Feedback Survey

Introduction

CheckUP provides access to outreach health services for urban, rural and remote communities across Queensland. Our aim is to deliver excellent services to people throughout Queensland.

Feedback about the service you received today is very important to us. This feedback helps our services to be of the highest standard and quality.

Thank you for completing the survey below.

Question Title

* 1. Are you Aboriginal and/or Torres Strait Islander?

Yes

Question Title

* 2. What is the NAME of the clinic you visited today?

Question Title

* 3. Where was the LOCATION of this service? eg Mount Isa, Gladstone

Question Title

* 4. What was the appointment or service you received? eg Podiatry, Psychology, Optometry

Question Title

* 5. Who did you see? eg Dr John Citizen

Question Title

* 6. How many kms did you need to travel to get to your appointment today?

Question Title

* 7. How did you feel about your visit?

Very satisfied

Satisfied

Neither satisfied nor dissatisfied

Dissatisfied

Very dissatisfied

Question Title

* 8. How likely would you come back to the clinic again?

Very likely

Likely

Neither likely nor unlikely

Unlikely

Very unlikely

Question Title

* 9. What would you tell your family about the clinic? The clinic was...

Excellent

Good

Neither Good nor Bad

Bad

Very Bad

Question Title

* 10. Did you get the help you wanted?

Yes

Partly

Not sure

Question Title

* 11. Do you think the visit today will help make you feel better?

Yes

Maybe

Question Title

* 12. Did the staff work together to care for you today?

Yes

Additional comments

Question Title

* 13. Did you feel listened to?

Yes

Additional comments

Question Title

* 14. Was it clearly explained what you need to do now?

Yes

Additional comments

Question Title

* 15. If this service was unavailable, how else would you access a similiar service?

Travel further (between 1-2 hours further)

Travel further (2 or more hours further)

Would NOT be able to access another similar service

Comments

Question Title

* 16. How long was the timeframe from when you received your referral for this appointment, to when you saw the health practitioner?

Up to 1 week

Up to 1 month

Up to 3 months

Up to 6 months

Great than 6 months

Question Title

* 17. Were you charged a fee for this service?

Yes

Question Title

* 18. What would you do if this service was available more often through a telehealth service? (still including the face to face service)

Yes I would use the telehealth service in between the face to face visits if needed

No I would prefer to wait to see the health practitioner in person

Unsure

Question Title

* 19. Please select all the technology devices you currently use in your day to day life

Smart phone

Tablet

Laptop or desktop computer

non

other

Other (please specify)

Question Title

* 20. Have there been any problems with your care?

Question Title

* 21. Tell us what we can do better?

If you would like to be contacted to discuss the service or your feedback, please provide your contact details below

Question Title

* 22. Please provide the following details

Name

Email Address

Phone Number

General Practice Queensland Limited ACN 123 426 111 trading as CheckUP Australia (CheckUP) is committed to protecting your privacy in accordance with the Privacy Act 1988 (Cth) (Privacy Act). If you give us your name and contact details, we will store it so we can get in touch with you. Your name and contact details are personal information. The CheckUP Privacy Policy, available on the CheckUP website, describes how CheckUP complies with the Privacy Act and keeps your information private. It contains information about how you can find out what information we’ve collected, get that information fixed if it’s not right, how you can make a complaint about us not doing the right thing under the law with your personal information, and how we will manage any complaint made by you. CheckUP is collecting your personal information to obtain feedback in relation to a health service you have recently accessed, which has been delivered to you by a CheckUP contracted Outreach Service Provider. Non-identified information may also be shared with the Australian Government for statistical, evaluation and management purposes. If you choose not to provide your contact details, then CheckUP will not be able to contact you in relation to the feedback you have provided. Your personal information may be disclosed to overseas recipients including servers located in the United States or Canada where SurveyMonkey has been used. If you would like make changes to your contact details, please email qualitycontact@checkup.org.au.

Thank you for completing the feedback form.

If you would like to contact the Outreach service team please email outreachservices@checkup.org.au

Alternatively, you can contact the clinic if you have any questions about CheckUP or the feedback you have provided.