Athens District Family Health Team Patient Survey QIP 2015

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* 1. What month and year are you filling out this survey in? (We use this for in-office stats).

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* 2. Your Age?

Under 18

18-30

31-40

41-50

51-60

60+

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* 3. Gender

Male

Female

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* 4. How do you rate your health in general?

Poor

Fair

Good

Excellent

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* 5. Who do you have your appointment with today? Please check the appropriate box:

Family Physician

Nurse Practitioner

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* 6. The last time you were sick, how many “business days”* did it take from when you first tried to see your doctor or nurse practitioner to when you actually SAW him/her in their office? * Please note to calculate "business days" count only weekdays, Monday through Friday.

If you answered 2-19 days, 20 or more days or not applicable please go to next questions below.
However if you answered Same Day or Next Day please skip to Question # 9.

Same Day

Next Day

2-19 Days

20 Or More Days

Not Applicable

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* 7. If you selected 2-19 days above, indicate how many days it took to be seen?

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* 8. If you answered 2-19 days, 20 or more days or not applicable above, please choose one of the following answers that best suits reason that you were scheduled later than same day/next day:

This was earliest appointment available

Follow up visit (i.e. Asked to come back for 2 week follow up)

Requested appointment with specific provider (for example only wanted to see the NP, not the doctor)

You as patient, did not have availability for appointment sooner, or need for appointment was not urgent

Healthcare Professional

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* 9. When you see your doctor or nurse practitioner, how often do they or someone else in the office give you an opportunity to ask questions about recommended treatment?

Always

Often

Sometimes

Rarely

Never

Not Applicable

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* 10. When you see your doctor or nurse practitioner, how often do they or someone else in the office involve you as much as you want to be in decisions about your care and treatment?

Always

Often

Sometimes

Rarely

Never

Not Applicable

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* 11. When you see your doctor or nurse practitioner, how often do they or someone in the office spend enough time with you?

Always

Often

Sometimes

Rarely

Never

Not Applicable

After Hours Care

Are you aware of the following services?

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* 12. Are you aware of our After Hours Clinics (Held on Tuesday and Thursday evenings)?

Yes

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* 13. Are you aware of our NEW website (www.adfht.on.ca)?

Yes

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* 14. Are you aware of the Telephone Health Advisory Service (i.e. who to call for medical advice when we are closed)? If you are not aware the contact # for this service is 1-866-553-7205.

Yes

Do you use the following services?

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* 15. Do you use the After Hours Clinics (Runs on Tuesday and Thursday evenings)?

Yes

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* 16. Do you use our NEW website (www.adfht.on.ca)?

Yes

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* 17. Do you use the Telephone Health Advisory Service (i.e. who to call for medical advice when we are closed)? If you don't know the contact # for this it is 1-866-553-7205

Yes

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* 18. Please share any comments you may have about the After Hours Clinic, Website, or Telephone Health Advisory Service.

Your Thoughts on Our Clinic

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* 19. Using the ratings below, please check the appropriate box that corresponds to your level of satisfaction regarding your appointments at our clinic.

	Very Satisfied	Satisfied	Dissatisfied	Very Dissatisfied	I Don't Know (?)	Not Applicable
Ease of reaching us by telephone	Ease of reaching us by telephone Very Satisfied	Ease of reaching us by telephone Satisfied	Ease of reaching us by telephone Dissatisfied	Ease of reaching us by telephone Very Dissatisfied	Ease of reaching us by telephone I Don't Know (?)	Ease of reaching us by telephone Not Applicable
Interaction with reception staff	Interaction with reception staff Very Satisfied	Interaction with reception staff Satisfied	Interaction with reception staff Dissatisfied	Interaction with reception staff Very Dissatisfied	Interaction with reception staff I Don't Know (?)	Interaction with reception staff Not Applicable
Staff treated me in a respectful and confidential manner	Staff treated me in a respectful and confidential manner Very Satisfied	Staff treated me in a respectful and confidential manner Satisfied	Staff treated me in a respectful and confidential manner Dissatisfied	Staff treated me in a respectful and confidential manner Very Dissatisfied	Staff treated me in a respectful and confidential manner I Don't Know (?)	Staff treated me in a respectful and confidential manner Not Applicable
I felt comfortable being at the clinic to receive care	I felt comfortable being at the clinic to receive care Very Satisfied	I felt comfortable being at the clinic to receive care Satisfied	I felt comfortable being at the clinic to receive care Dissatisfied	I felt comfortable being at the clinic to receive care Very Dissatisfied	I felt comfortable being at the clinic to receive care I Don't Know (?)	I felt comfortable being at the clinic to receive care Not Applicable
I felt satisfied with the services provided at the clinic	I felt satisfied with the services provided at the clinic Very Satisfied	I felt satisfied with the services provided at the clinic Satisfied	I felt satisfied with the services provided at the clinic Dissatisfied	I felt satisfied with the services provided at the clinic Very Dissatisfied	I felt satisfied with the services provided at the clinic I Don't Know (?)	I felt satisfied with the services provided at the clinic Not Applicable
I would recommend this clinic to others	I would recommend this clinic to others Very Satisfied	I would recommend this clinic to others Satisfied	I would recommend this clinic to others Dissatisfied	I would recommend this clinic to others Very Dissatisfied	I would recommend this clinic to others I Don't Know (?)	I would recommend this clinic to others Not Applicable
Length of time in exam room waiting for care Provider	Length of time in exam room waiting for care Provider Very Satisfied	Length of time in exam room waiting for care Provider Satisfied	Length of time in exam room waiting for care Provider Dissatisfied	Length of time in exam room waiting for care Provider Very Dissatisfied	Length of time in exam room waiting for care Provider I Don't Know (?)	Length of time in exam room waiting for care Provider Not Applicable
Do you think having a team of healthcare professionals has improved your quality of care?	Do you think having a team of healthcare professionals has improved your quality of care? Very Satisfied	Do you think having a team of healthcare professionals has improved your quality of care? Satisfied	Do you think having a team of healthcare professionals has improved your quality of care? Dissatisfied	Do you think having a team of healthcare professionals has improved your quality of care? Very Dissatisfied	Do you think having a team of healthcare professionals has improved your quality of care? I Don't Know (?)	Do you think having a team of healthcare professionals has improved your quality of care? Not Applicable

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* 20. Are there services not presently available at the clinic or in the community that you would like to see the Athens District Family Health Team offer? If so, which ones?

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* 1. What month and year are you filling out this survey in? (We use this for in-office stats).

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* 2. Your Age?

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* 3. Gender

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* 4. How do you rate your health in general?

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* 5. Who do you have your appointment with today? Please check the appropriate box:

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* 7. If you selected 2-19 days above, indicate how many days it took to be seen?

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* 8. If you answered 2-19 days, 20 or more days or not applicable above, please choose one of the following answers that best suits reason that you were scheduled later than same day/next day:

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* 9. When you see your doctor or nurse practitioner, how often do they or someone else in the office give you an opportunity to ask questions about recommended treatment?

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* 10. When you see your doctor or nurse practitioner, how often do they or someone else in the office involve you as much as you want to be in decisions about your care and treatment?

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* 11. When you see your doctor or nurse practitioner, how often do they or someone in the office spend enough time with you?

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* 12. Are you aware of our After Hours Clinics (Held on Tuesday and Thursday evenings)?

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* 13. Are you aware of our NEW website (www.adfht.on.ca)?

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* 14. Are you aware of the Telephone Health Advisory Service (i.e. who to call for medical advice when we are closed)? If you are not aware the contact # for this service is 1-866-553-7205.

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* 15. Do you use the After Hours Clinics (Runs on Tuesday and Thursday evenings)?

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* 16. Do you use our NEW website (www.adfht.on.ca)?

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* 17. Do you use the Telephone Health Advisory Service (i.e. who to call for medical advice when we are closed)? If you don't know the contact # for this it is 1-866-553-7205

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* 18. Please share any comments you may have about the After Hours Clinic, Website, or Telephone Health Advisory Service.

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* 19. Using the ratings below, please check the appropriate box that corresponds to your level of satisfaction regarding your appointments at our clinic.

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* 20. Are there services not presently available at the clinic or in the community that you would like to see the Athens District Family Health Team offer? If so, which ones?

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* 21. Is there anything else you would like to provide feedback on and tell us about?