We want to hear from you!

You are being invited to take part in this survey because you have recently had a visit at the Kapuskasing and Area Family Health Team.

Your responses to the questions on this survey will help us improve the care we provide. There are six sections of the survey and it will take approximately 5 minutes to complete.

Participation in the 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? If you are completing this survey for someone else, who are you completing it for?

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

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* 3. 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

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* 4. Thinking about the MAIN health care provider you spoke with during the 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 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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* 5. 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
Your confidence in the doctor/ health care provider(s) you saw during the 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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* 6. The last time you were sick or were concerned you had a health problem, how many days did it take from when you first tried to see your doctor or nurse practitioner to when you actually SAW him/her or someone else in their office?

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* 7. 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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* 8. 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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* 9. FEEDBACK (OPTIONAL)

Thinking of your overall experience with our office/clinic, what are two things done particularly well and two things that could be improved? Please provide any other additional feedback you would like to share with us that could help us improve the way we provide care.

The Kapuskasing and Area Family Health Team thanks you for your time.
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