Wawa Family Health Team PATIENT EXPERIENCE SURVEY

You are being invited to take part in this survey if you have recently had a visit at Wawa Family Health Team. Your responses to the questions on this survey will help us improve the care we provide. The survey will take approximately five minutes to complete

Participation in the survey is completely voluntary and all your responses to the survey questions will be kept confidential.

Question Title

* 1. Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the following?
The length of time it took between making your appointment and the visit you just had

Poor

Fair

Good

Very Good

Excellent

Question Title

* 2. 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 their office?

Same day

Next day

2-19 days (enter number of days below)

20 or more days

Not applicable (don't know / refused)

Number of days:

Question Title

* 3. Still thinking about your most recent visit; on a scale of poor to excellent, how would you rate the following?
Your overall experience with our reception staff

Poor

Fair

Good

Very Good

Excellent

Question Title

* 4. Thinking about your experiences over the last year or so, were there any barriers to accessing our services?

Somewhat

Yes ( please answer in the space provided)

Question Title

* 5. When you see your doctor or Nurse Practitioner, how often do they or someone else in the office...

	Never	Rarely	Sometimes	Often	Always
Give you an opportunity to ask questions about recommended treatment	Give you an opportunity to ask questions about recommended treatment Never	Give you an opportunity to ask questions about recommended treatment Rarely	Give you an opportunity to ask questions about recommended treatment Sometimes	Give you an opportunity to ask questions about recommended treatment Often	Give you an opportunity to ask questions about recommended treatment Always
Involve you as much as you want to be in decisions about your care and treatment	Involve you as much as you want to be in decisions about your care and treatment Never	Involve you as much as you want to be in decisions about your care and treatment Rarely	Involve you as much as you want to be in decisions about your care and treatment Sometimes	Involve you as much as you want to be in decisions about your care and treatment Often	Involve you as much as you want to be in decisions about your care and treatment Always
Spend enough time with you	Spend enough time with you Never	Spend enough time with you Rarely	Spend enough time with you Sometimes	Spend enough time with you Often	Spend enough time with you Always

Question Title

* 6. Is there any additional information or feedback you would like to share with us that could help us improve the way we provide care?

Please comment below

Other (please specify)

Question Title

* 1. Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the following?The length of time it took between making your appointment and the visit you just had

Question Title

* 2. 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 their office?

Question Title

* 3. Still thinking about your most recent visit; on a scale of poor to excellent, how would you rate the following?Your overall experience with our reception staff

Question Title

* 4. Thinking about your experiences over the last year or so, were there any barriers to accessing our services?

Question Title

* 5. When you see your doctor or Nurse Practitioner, how often do they or someone else in the office...

Question Title

* 6. Is there any additional information or feedback you would like to share with us that could help us improve the way we provide care?

* 1. Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the following?
The length of time it took between making your appointment and the visit you just had

* 3. Still thinking about your most recent visit; on a scale of poor to excellent, how would you rate the following?
Your overall experience with our reception staff