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Thank you for answering this short survey about your care as a patient at the Bancroft Community Family Health Team. Please note that your answers will be kept confidential. Your name will not be collected.

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* 1. Age

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* 2. Self-identified gender

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* 3. Do you have a Primary Care Provider (Doctor or Nurse Practitioner)?

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* 4. Thinking about the MOST RECENT time you received care in the clinic or virtually, which healthcare provider did you connect with? (select one)

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* 5. Thinking about the MOST RECENT time you booked your appointment, approximately, how many days did you wait to connect with your healthcare provider?

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* 6. Did you feel that your health concern needed to be addressed within the same day or next day?

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* 7. When you connect with your healthcare provider, do they involve you as much as you want to be in decisions about your care and treatment? (select one)

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* 8. Do you feel welcome and comfortable when you attend the office for an appointment? (select one)

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* 9. Thinking about the MOST RECENT time you received care, how did you connect with your provider? (select one)

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* 10. Please rate your preferred methods for contacting your provider from 1-3.  1 being most preferred, and 3 as least preferred.  (use arrows to move answers up and down to rank your preference)

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* 11. Please rate your preferred methods for visiting your provider from 1-3.  1 being most preferred, and 3 as least preferred. (use arrows to move answers up and down to rank your preference)

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* 12. What limitations or barriers prevent you from connecting with your provider virtually either by phone or online (please select all that apply)?

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* 13. What limitations or barriers prevent you from accessing healthcare in your community? (please select or list all that apply)

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* 14. In general, how would you rate your overall health? (select one)

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* 15. How would you rate your overall experience with care provided? (select one)

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* 16. The BCFHT offers educational group sessions for health management (i.e. diet, diabetes, grief group, etc.).  If you were to attend an educational group session, do you prefer virtual/video or in-person sessions? (select one)

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* 17. If you were to attend an educational group session, what time of day is preferred? (select one)

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* 18. Do you have any other comments you would like to share?

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