Preamble

You are being invited to take part in this survey because you have recently had a visit at 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.

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* 1. On your most recent visit to the clinic your appointment was with:  (Please check all that apply)

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* 2. 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 length of time it took between making your appointment and the visist you just had
Your overall experience accessing the office clinic

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* 3. 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?

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* 4. In your opinion was your appointment booked within an acceptable timeframe?

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* 5. 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

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* 6. 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 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

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* 7. Your experiences visiting with us over the last year or so......  The first couple of questions are similar to the ones asked earlier, however instead of thinking about your most recent visit, we would like you to think more broadly....about your experience with us over the past year or so..... 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

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* 8. Would you recommend our services to your family or friends? Check one only...

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* 9. Thinking of your overall experience with our clinic, what have we done particulary well or what could be improved?

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* 10. Is there someone that provided you with an outstanding experience that you would like to recognize?

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