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* 1. What is your gender?

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* 2. What is your age?

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* 3. Please identify the location(s) where you most have accessed Prime Care services in the last 12 months.

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* 4. Based on your experience over the last 12 months, please rate the following.

  Very Poor Poor Fair Good Very Good Not Applicable to Me
Services provided by the Reception Team
Care given by our Nurse Practitioners
Care given by our Registered Nurses (Diabetes Educator)
Care given by our Respiratory Therapist
Care given by our Mental Health Counsellors
Care given by our Dietitian
Care given by our Physician Assistant
Care given by our Chiropodist
Care given by our Psychologist

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* 5. 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 the office?

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* 6. When you see your Doctor or Nurse Practitioner:

  Always Often Sometimes Rarely Never Not Applicable (Don't Know/Refused)
How often do they or someone else in the office involve you as much as you want to be in decisions about your care and treatment?
Do they or someone else in the office spend enough time with you?
Do they or someone else in the office give you an opportunity to ask questions about recommended treatment?

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* 7. Please identify the programs you have used at Prime Care in the last 12 months (if none, move on to the next question).

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* 8. Do you agree with the following statements about the care you received at Prime Care?

  Strongly Disagree Disagree Neutral Agree Strongly Agree Not Applicable
I can book an appointment for when I need it.
I know a Physician is available after hours and/or on weekends for urgent care.
I feel I am provided with enough information to make informed decisions about my health care.

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* 9. Overall, how would you rate your experience at Prime Care?

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* 10. Would you recommend Prime Care to your friends and family?

T