KDCHC Patient Experience Survey

You are being invited to take part in this survey because you have recently had an appointment with a Doctor or a Nurse Practitioner at Kitchener Downtown Community Health Centre. Your responses to the questions on this survey will help us improve the care we provide. There are 28 questions and it will take you approximately 15 minutes to complete.

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

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* 1. Are you completing this survey for yourself or for another person?

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* 2. If you are completing this survey for someone else, who are you completing it for?

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* 3. What services have you accessed at our centre this year? Check all that apply.

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* 4. What type of appointments have you attended this year? Check all that apply.

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* 5. Did the Face to Face appointment meet your needs?

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* 6. Did the phone call appointment meet your needs?

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* 7. Did the virtual appointment meet your needs?

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* 8. How do you usually travel to KDCHC? Check all that apply.

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* 9. If you usually travel to KDCHC by car, how easy was it to find parking?

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* 10. How was the appointment for your most recent visit made?

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

  Poor Fair Good Very Good Excellent
a.  The length of time it took between making your appointment and the visit you just had
b.  Availability of an interpreter, when needed
c.  My ability to physically access the areas I needed to get to at KDCHC
d.  Your overall experience accessing the office/clinic

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

  Poor Fair Good Very Good Excellent
The length of time you had to wait in the reception/waiting area
Your overall experience with our reception staff
The length of time you had to wait in the examination room before you spoke with the health care provider about the reason for your visit
I felt comfortable and welcome

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

  Poor Fair Good Very Good Excellent
They knew about your medical history
They listened to your concerns
They spoke using a language you could understand
They explained things in a way that was easy to understand
They were sensitive to your needs and preferences
They treated you with dignity and respect
They made you feel comfortable and welcome
They gave you clear instructions about what you need to do after your visit
Your overall experience speaking with the health care provider about the reason for your visit

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

  Poor Fair Good Very Good Excellent
The overall cleanliness of the office/clinic
The overall physical comfort of the office/clinic
The confidence in the doctor/health care provider(s) you saw during your visit
Your confidence that your health information was treated with the level of privacy you expect
Your overall experience with the visit you had with us

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* 15. The first couple of questions below are similar to ones asked earlier. However, instead of thinking about your most recent visit, we'd like you to think more broadly...about your experiences with us over the last year or so. The last time you were sick or were concerned you had a health problem...

  Yes No
Did you get an appointment on the date you wanted?
Were you able to see your doctor or nurse practitioner on the same day or next day?

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* 16. How many days did it take from when you first tried to see your doctor or nurse practitioner to when you actually SAW them or someone else in their office?

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* 17. When you see your doctor or nurse practitioner, how often do they or someone else in the office...?

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

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* 18. Over the last year or so, did you receive care from a health care provider(s) at a location other than this practice?

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* 19. Thinking about the health care provider(s) that you have seen at the different places you have received care over the last year or so, how often...?

  Never Rarely Sometimes Often Always
Did each seem to know your medical history
Did each seem to have your recent tests or exam results
Were they consistent in what they were telling you about your care and treatment?
Did the other health care provider(s) that you saw at the different places seem to work well together in caring for you

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* 20. On another issue, the last time when you needed medical care in the evening, on a weekend, or on a public holiday, how easy was it to get care without going to the emergency department?

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* 21. My top 2 health goals include improved:

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* 22. My top 3 barriers to reaching my health goals:

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* 23. To help me reach my health goals, I suggest Kitchener Downtown CHC offers:

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* 24. In general how would you rate your overall health?

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* 25. How long have you been visiting Kitchener Downtown Community Health Centre for your health care?

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* 26. Using your best guess, how many times did you visit Kitchener Downtown Community Health Centre over the last year or so for your own medical care?

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* 27. Would you recommend Kitchener Downtown Community Health Centre services to your family or friends?

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* 28. Additional feedback on things KDCHC does well or could be improved upon

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* 29. Thank you for completing our survey. Please call Judy at 519-745-4404 x208 to receive your $5 Sobeys gift card. You will be required to leave your name and contact information.

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