Introduction

Our goal is to provide timely and high quality services to improve the quality of life for our patients.  Would you please take a couple of minutes to complete this questionnaire in order to help us to understand what we are doing well and what we can improve on? 

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* 1. How long have you been visiting us for your health care?

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* 2. Please indicate your gender.

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* 3. Please indicate your age group.

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

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* 5. Using your best guess, how many times did you visit us over the last year or so for your own medical care?

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* 6. Who is your family physician? 

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* 7. Using any number from 0 to 10, where 0 is the worst health care possible and 10 is the best health care possible, what number would you use to rate the Smithville Medical Centre Family Health Team?

  10 Best health care possible 9 8 7 6 5 4 3 2 1 0 Worst health care possible
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