Patient Experience survey

Preamble

You are being invited to take part in this survey because you have recently had an appointment at  the North Bay Nurse Practitioner-Led Clinic.  Your responses to the questions on this survey will help us improve the care we provide.  There are five (5) 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 are kept confidential and anonymous.
1.Thinking about your most recent appointment, on a scale of poor to excellent, how would you rate the following:
Poor
Fair
Good
Very Good
Excellent
The length of time it took between making your appointment and the visit/phone appointment you just had
Your overall experience accessing the clinic to make the appointment
2.When making your current appointment how many days did it take from when you booked your appointment to when you actually saw someone in the office/or had a phone call appoinment?
3.In your opinion was your appointment booked within an acceptable timeframe?
4.On a scale of poor to excellent, how would you rate the following.....?
Poor
Fair
Good
Very Good
Excellent
If you were in the clinic, the length of time you had to wait in the reception/waiting area
Your overall experience with our reception staff
5.Thinking about the main health care provider you spoke with during the appointment, 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 relevant medical history (how it relates to your appointment)
They listened to your concerns
They explained things in a way that was easy to understand
They treated you with dignity and respect
They gave you clear instructions about what you need to do after your visit
Your confidence in the health care provider
Your confidence that health information was treated with the level of privacy you expect
The overall cleanliness of the clinic (if your appointment was in the clinic)
6.When you see your main health care provider, do they or someone else in the office........?
Never
Rarely
Sometimes
Often
Always
Give you an opportunity to ask questions about recommended treatment(s)
Involve you as much as you want to be in decisions about your care and treatment
Spend enough time with you
7.Would you recommend our services to your family or friends? Check one only...
8.Thinking of your overall experience with our clinic, what have we done particulary well or what could be improved?
9.Is there someone that provided you with an outstanding experience that you would like to recognize?
10.Which of our sites are you filling this survey out about?
11.To be entered into a draw to win a gift card, please leave your name and contact number.