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Experience Survey - Blind River
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1.
What department are you providing feedback for?
(Required.)
Emergency Department
Diagnostic Imaging
Laboratory
Rehabilitation/Physiotherapy
Clinical Dietician/Diabetes Educator
Nurse Practitioner Clinic
Other (please specify):
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2.
Who is completing this survey?
(Required.)
Patient, resident, or client
Family member or loved one
Care Partner or Support Person
Other (please specify):
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3.
What was the reason for your visit/your loved one's visit?
(Required.)
An accident or injury
A new health problem
An ongoing health problem
Other (please specify):
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4.
When you first arrived, how long was it before you were able to speak with someone about the reason you came to NSHN?
(Required.)
Less than 5 minutes
5-15 minutes
Over 15 minutes
Not applicable
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5.
If you had a scheduled appointment, were staff on time?
(Required.)
Called in before appointment time
On time
Within 5-10 minutes
Within 11-20 minutes
Within 21-30 minutes
Over 30 minutes
Not applicable, I didn't have a scheduled appointment time.
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6.
If you had a long wait, were you told why?
(Required.)
Yes.
No, but I would have liked a reason.
No, but I did not mind.
I did not have a long wait.
Not applicable.
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7.
Did you have the opportunity to ask questions?
(Required.)
Yes
No
Not applicable
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8.
Did you feel your personal information was kept confidential?
(Required.)
Yes
No
Not applicable
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9.
How often did you feel comfortable and safe with the Providers (Nurse Practitioner, Doctor) and/or staff?
(Required.)
Always
Often
Sometimes
Rarely
Never
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10.
How often did Providers and/or staff treat you with courtesy and respect?
(Required.)
Always
Often
Sometimes
Rarely
Never
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11.
How often did you feel that Providers and/or staff listened to you?
(Required.)
Always
Often
Sometimes
Rarely
Never
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12.
Were you asked about any medications you're currently taking at home, or any treatments, therapies, or supports you currently have in place?
(Required.)
Yes
No
Not applicable to the service I received (i.e., Lab)
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13.
Were you prescribed any *new* medications, treatments, therapies, or supports?
(Required.)
Yes
No
Not applicable to the service I received (i.e., Lab)
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14.
Were you provided with information on what these *new* medications, treatments, therapies, or supports were for, including possible side effects?
(Required.)
Yes
No
Not applicable to the service I received (i.e., Lab)
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15.
Were you provided with information on how to access your results if you had testing or imaging completed (i.e., Family Provider, PocketHealth, etc.)?
(Required.)
Yes
No
Not applicable
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16.
Did you receive enough information about what to do if you were worried about your condition or treatment after you left the hospital?
(Required.)
Yes
I received some information but I still have questions that weren't answered.
No, not at all.
Not applicable
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17.
Overall, how satisfied were you with the care or service you received?
(Required.)
Very satisfied
Satisfied
Neutral
Somewhat dissatisfied
Completely dissatisfied
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18.
Please rate your visit on a scale of 1 to 10 (with 1 being the lowest and 10 being the highest level of satisfaction).
(Required.)
1
2
3
4
5
6
7
8
9
10
19.
Comments:
20.
If you would like the Patient Relations Officer to contact you about your visit, please provide your name and contact information (phone number or email), below:
