Southlake Community OHT Patient Engagement Survey

Question Title

* 1. How old are you?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

Question Title

* 2. What is your primary language?

Question Title

* 3. Please enter the first three digits of your postal code (optional):

Question Title

* 4. Do you have a regular family doctor or nurse practitioner that you can access for most of your healthcare needs?

Yes

Not sure

Question Title

* 5. Where do you mainly go for your healthcare needs?

Family doctor

Walk-in clinic

Hospital Emergency Department (ED)

Other

Question Title

* 6. How satisfied are you with the following healthcare services?

	Never used	Very unsatisfied	Unsatisfied	Neutral	Satisfied	Very satisfied
Hospital services (e.g. ED wait times)	Hospital services (e.g. ED wait times) Never used	Hospital services (e.g. ED wait times) Very unsatisfied	Hospital services (e.g. ED wait times) Unsatisfied	Hospital services (e.g. ED wait times) Neutral	Hospital services (e.g. ED wait times) Satisfied	Hospital services (e.g. ED wait times) Very satisfied
Family doctor (e.g. wait times to see your doctor)	Family doctor (e.g. wait times to see your doctor) Never used	Family doctor (e.g. wait times to see your doctor) Very unsatisfied	Family doctor (e.g. wait times to see your doctor) Unsatisfied	Family doctor (e.g. wait times to see your doctor) Neutral	Family doctor (e.g. wait times to see your doctor) Satisfied	Family doctor (e.g. wait times to see your doctor) Very satisfied
Specialists (e.g. wait times to see a cardiologist)	Specialists (e.g. wait times to see a cardiologist) Never used	Specialists (e.g. wait times to see a cardiologist) Very unsatisfied	Specialists (e.g. wait times to see a cardiologist) Unsatisfied	Specialists (e.g. wait times to see a cardiologist) Neutral	Specialists (e.g. wait times to see a cardiologist) Satisfied	Specialists (e.g. wait times to see a cardiologist) Very satisfied
Mental health and addiction services	Mental health and addiction services Never used	Mental health and addiction services Very unsatisfied	Mental health and addiction services Unsatisfied	Mental health and addiction services Neutral	Mental health and addiction services Satisfied	Mental health and addiction services Very satisfied
Home care services	Home care services Never used	Home care services Very unsatisfied	Home care services Unsatisfied	Home care services Neutral	Home care services Satisfied	Home care services Very satisfied
Rehabilitation services	Rehabilitation services Never used	Rehabilitation services Very unsatisfied	Rehabilitation services Unsatisfied	Rehabilitation services Neutral	Rehabilitation services Satisfied	Rehabilitation services Very satisfied
Walk-in clinic services	Walk-in clinic services Never used	Walk-in clinic services Very unsatisfied	Walk-in clinic services Unsatisfied	Walk-in clinic services Neutral	Walk-in clinic services Satisfied	Walk-in clinic services Very satisfied
Children and youth services	Children and youth services Never used	Children and youth services Very unsatisfied	Children and youth services Unsatisfied	Children and youth services Neutral	Children and youth services Satisfied	Children and youth services Very satisfied

Question Title

* 7. Which areas would you like to see improvements in? Select top 3 choices.

I would like shorter hospital ED wait times

I would like to have access to my medical records easily

I would like shorter wait times to see a specialist

I want to be able to find healthcare services easier

I want all of my healthcare providers to coordinate my care

Question Title

* 8. How would you like to be contacted to give feedback on the Southlake Community Ontario Health Team? Select all that apply.

Online survey

In-person conversation

Webinar

Telephone call/ survey

Other (please specify)