Patient Experience Survey

You are being invited to take part in this survey because you have recently had a visit at Georgian Nurse Practitioner Led Clinic. Your responses to the questions on this survey will help us improve the care we provide. There are five (5) sections of the survey and it will take approximately 5 minutes to complete.

Participation in the survey is completely voluntary and all your responses to the survey questions will be kept confidential and anonymous.

	Poor	Fair	Good	Very Good	Excellent
The length of time it took between making your appointment and the visit you just had	The length of time it took between making your appointment and the visit you just had Poor	The length of time it took between making your appointment and the visit you just had Fair	The length of time it took between making your appointment and the visit you just had Good	The length of time it took between making your appointment and the visit you just had Very Good	The length of time it took between making your appointment and the visit you just had Excellent
Your overall experience accessing the office/clinic	Your overall experience accessing the office/clinic Poor	Your overall experience accessing the office/clinic Fair	Your overall experience accessing the office/clinic Good	Your overall experience accessing the office/clinic Very Good	Your overall experience accessing the office/clinic Excellent

Poor

Fair

Good

Very Good

Excellent

The length of time it took between making your appointment and the visit you just had

The length of time it took between making your appointment and the visit you just had Poor

The length of time it took between making your appointment and the visit you just had Fair

The length of time it took between making your appointment and the visit you just had Good

The length of time it took between making your appointment and the visit you just had Very Good

The length of time it took between making your appointment and the visit you just had Excellent

Your overall experience accessing the office/clinic

Your overall experience accessing the office/clinic Poor

Your overall experience accessing the office/clinic Fair

Your overall experience accessing the office/clinic Good

Your overall experience accessing the office/clinic Very Good

Your overall experience accessing the office/clinic Excellent

	Poor	Fair	Good	Very Good	Excellent
The length of time you had to wait in the reception/waiting area	The length of time you had to wait in the reception/waiting area Poor	The length of time you had to wait in the reception/waiting area Fair	The length of time you had to wait in the reception/waiting area Good	The length of time you had to wait in the reception/waiting area Very Good	The length of time you had to wait in the reception/waiting area Excellent
Your overall experience with our reception staff	Your overall experience with our reception staff Poor	Your overall experience with our reception staff Fair	Your overall experience with our reception staff Good	Your overall experience with our reception staff Very Good	Your overall experience with our reception staff Excellent

Poor

Fair

Good

Very Good

Excellent

The length of time you had to wait in the reception/waiting area

The length of time you had to wait in the reception/waiting area Poor

The length of time you had to wait in the reception/waiting area Fair

The length of time you had to wait in the reception/waiting area Good

The length of time you had to wait in the reception/waiting area Very Good

The length of time you had to wait in the reception/waiting area Excellent

Your overall experience with our reception staff

Your overall experience with our reception staff Poor

Your overall experience with our reception staff Fair

Your overall experience with our reception staff Good

Your overall experience with our reception staff Very Good

Your overall experience with our reception staff Excellent

	Poor	Fair	Good	Very Good	Excellent
They knew about your relevant medical history (how it relates to your appointment)	They knew about your relevant medical history (how it relates to your appointment) Poor	They knew about your relevant medical history (how it relates to your appointment) Fair	They knew about your relevant medical history (how it relates to your appointment) Good	They knew about your relevant medical history (how it relates to your appointment) Very Good	They knew about your relevant medical history (how it relates to your appointment) Excellent
They listened to your concerns	They listened to your concerns Poor	They listened to your concerns Fair	They listened to your concerns Good	They listened to your concerns Very Good	They listened to your concerns Excellent
They explained things in a way that was easy to understand	They explained things in a way that was easy to understand Poor	They explained things in a way that was easy to understand Fair	They explained things in a way that was easy to understand Good	They explained things in a way that was easy to understand Very Good	They explained things in a way that was easy to understand Excellent
They treated you with dignity and respect	They treated you with dignity and respect Poor	They treated you with dignity and respect Fair	They treated you with dignity and respect Good	They treated you with dignity and respect Very Good	They treated you with dignity and respect Excellent
They gave you clear instructions about what you need to do after your visit	They gave you clear instructions about what you need to do after your visit Poor	They gave you clear instructions about what you need to do after your visit Fair	They gave you clear instructions about what you need to do after your visit Good	They gave you clear instructions about what you need to do after your visit Very Good	They gave you clear instructions about what you need to do after your visit Excellent
Your confidence in the health care provider	Your confidence in the health care provider Poor	Your confidence in the health care provider Fair	Your confidence in the health care provider Good	Your confidence in the health care provider Very Good	Your confidence in the health care provider Excellent
Your confidence that health information was treated with the level of privacy you expect	Your confidence that health information was treated with the level of privacy you expect Poor	Your confidence that health information was treated with the level of privacy you expect Fair	Your confidence that health information was treated with the level of privacy you expect Good	Your confidence that health information was treated with the level of privacy you expect Very Good	Your confidence that health information was treated with the level of privacy you expect Excellent
The overall cleanliness of the clinic	The overall cleanliness of the clinic Poor	The overall cleanliness of the clinic Fair	The overall cleanliness of the clinic Good	The overall cleanliness of the clinic Very Good	The overall cleanliness of the clinic Excellent

Poor

Fair

Good

Very Good

Excellent

They knew about your relevant medical history (how it relates to your appointment)

They knew about your relevant medical history (how it relates to your appointment) Poor

They knew about your relevant medical history (how it relates to your appointment) Fair

They knew about your relevant medical history (how it relates to your appointment) Good

They knew about your relevant medical history (how it relates to your appointment) Very Good

They knew about your relevant medical history (how it relates to your appointment) Excellent

They listened to your concerns

They listened to your concerns Poor

They listened to your concerns Fair

They listened to your concerns Good

They listened to your concerns Very Good

They listened to your concerns Excellent

They explained things in a way that was easy to understand

They explained things in a way that was easy to understand Poor

They explained things in a way that was easy to understand Fair

They explained things in a way that was easy to understand Good

They explained things in a way that was easy to understand Very Good

They explained things in a way that was easy to understand Excellent

They treated you with dignity and respect

They treated you with dignity and respect Poor

They treated you with dignity and respect Fair

They treated you with dignity and respect Good

They treated you with dignity and respect Very Good

They treated you with dignity and respect Excellent

They gave you clear instructions about what you need to do after your visit

They gave you clear instructions about what you need to do after your visit Poor

They gave you clear instructions about what you need to do after your visit Fair

They gave you clear instructions about what you need to do after your visit Good

They gave you clear instructions about what you need to do after your visit Very Good

They gave you clear instructions about what you need to do after your visit Excellent

Your confidence in the health care provider

Your confidence in the health care provider Poor

Your confidence in the health care provider Fair

Your confidence in the health care provider Good

Your confidence in the health care provider Very Good

Your confidence in the health care provider Excellent

Your confidence that health information was treated with the level of privacy you expect

Your confidence that health information was treated with the level of privacy you expect Poor

Your confidence that health information was treated with the level of privacy you expect Fair

Your confidence that health information was treated with the level of privacy you expect Good

Your confidence that health information was treated with the level of privacy you expect Very Good

Your confidence that health information was treated with the level of privacy you expect Excellent

The overall cleanliness of the clinic

The overall cleanliness of the clinic Poor

The overall cleanliness of the clinic Fair

The overall cleanliness of the clinic Good

The overall cleanliness of the clinic Very Good

The overall cleanliness of the clinic Excellent

	Never	Rarely	Sometimes	Often	Always
Give you an opportunity to ask questions about recommended treatment	Give you an opportunity to ask questions about recommended treatment Never	Give you an opportunity to ask questions about recommended treatment Rarely	Give you an opportunity to ask questions about recommended treatment Sometimes	Give you an opportunity to ask questions about recommended treatment Often	Give you an opportunity to ask questions about recommended treatment Always
involve you as much as you want to be in decisions about your care and treatment	involve you as much as you want to be in decisions about your care and treatment Never	involve you as much as you want to be in decisions about your care and treatment Rarely	involve you as much as you want to be in decisions about your care and treatment Sometimes	involve you as much as you want to be in decisions about your care and treatment Often	involve you as much as you want to be in decisions about your care and treatment Always
Spend enough time with you	Spend enough time with you Never	Spend enough time with you Rarely	Spend enough time with you Sometimes	Spend enough time with you Often	Spend enough time with you Always

Never

Rarely

Sometimes

Often

Always

Give you an opportunity to ask questions about recommended treatment

Give you an opportunity to ask questions about recommended treatment Never

Give you an opportunity to ask questions about recommended treatment Rarely

Give you an opportunity to ask questions about recommended treatment Sometimes

Give you an opportunity to ask questions about recommended treatment Often

Give you an opportunity to ask questions about recommended treatment Always

involve you as much as you want to be in decisions about your care and treatment

involve you as much as you want to be in decisions about your care and treatment Never

involve you as much as you want to be in decisions about your care and treatment Rarely

involve you as much as you want to be in decisions about your care and treatment Sometimes

involve you as much as you want to be in decisions about your care and treatment Often

involve you as much as you want to be in decisions about your care and treatment Always

Spend enough time with you

Spend enough time with you Never

Spend enough time with you Rarely

Spend enough time with you Sometimes

Spend enough time with you Often

Spend enough time with you Always

Patient Experience Survey

Summary

Question Title

* 1. A. When visiting our clinic today your appointment was with? please check all that apply.

Question Title

* 2. Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the following...?

Question Title

* 3. When making your current appointment how many days did it take from when you booked your appointment to when you actually say someone in this office?

Question Title

* 4. In your opinion was your appointment booked within an acceptable timeframe?

Question Title

* 5. On a scale of poor to excellent, how would you rate the following...?

Question Title

* 6. Thinking about the MAIN health care provider you spoke with during the visit, on a scale of poor to excellent, how would you rate this person on the following...?

Question Title

Question Title

* 8. Would you recommend our services to your family or friends? Check ONE only

Question Title

* 9. Thinking of your overall experience with our office/Clinic what
Have we done particularly well? Could be Improved

Question Title

* 10. Is there someone that provided you with an outstanding experience that you would like to recognize?

Question Title

* 1. A. When visiting our clinic today your appointment was with? please check all that apply.

Question Title

* 2. Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the following...?

Question Title

* 3. When making your current appointment how many days did it take from when you booked your appointment to when you actually say someone in this office?

Question Title

* 4. In your opinion was your appointment booked within an acceptable timeframe?

Question Title

* 5. On a scale of poor to excellent, how would you rate the following...?

Question Title

* 6. Thinking about the MAIN health care provider you spoke with during the visit, on a scale of poor to excellent, how would you rate this person on the following...?

Question Title

Question Title

* 8. Would you recommend our services to your family or friends? Check ONE only

Question Title

* 9. Thinking of your overall experience with our office/Clinic whatHave we done particularly well? Could be Improved

Question Title

* 10. Is there someone that provided you with an outstanding experience that you would like to recognize?

* 9. Thinking of your overall experience with our office/Clinic what
Have we done particularly well? Could be Improved