Patient Feedback for Planning Purposes

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* 1. How long have you been receiving healthcare from staff at Portage Medical Family Health Team (PMFHT), located at 4256 Portage Road?

Less than a year

One to two years

Two to four years

Five years or more

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* 2. Please check all the services you have experienced/received from PMFHT.

Diabetes Management

Chronic Pain Management

Well Woman Program

Footcare

Physiotherapy

Mental Health Counselling

Nutrition Support

Smoking Cessation

Pharmacist Support

Hospital Discharge Follow-up

Memory Clinic

Walking Group participation

Parent Support Group participation

Other workshop participation

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* 3. Thinking of all your experiences with PMFHT, please rate your satisfaction by checking one of the following.

Very satisfied

Satisfied

Dissatisfied

Very dissatisfied

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* 4. PMFHT currently has the capability of delivering patient care in three ways. Please rank the following according to your personal preference, with one (1) being your most preferred; two (2) being less preferred and three (3) being your least preferred

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* 5. To help us improve your healthcare service, please check any and all that apply to you:

Indigenous

Inuit

Metis

English/French not first language

LGBTQ2S

Newcomer

Person with a disability

(state preferred language)

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* 6. What is the best way for PMFHT to share information with you?

Telephone

Letter mail

Other – provide details, please

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* 7. What has been your best PMFHT experience?

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* 8. What one thing would you improve about PMFHT?

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* 9. What one thing would you add to the services at PMFHT to improve your personal health?

Thank you!

If you have any questions or concerns, please contact

Portage Medical Family Health Team Executive Director,

Carol Stewart-Kirkby - 905-354-9393, ext. 222

carol.stewart-kirkby@portagemedicalfht.ca