Diagnostic Imaging/CardioRespiratory/ Laboratory - Patient and Family Experience Survey

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* 1. Who is completing this survey?

Patient

Family Member/Caregiver

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* 2. Your experience was at which Huron Health System Facility?

Alexandra Marine and General Hospital (AMGH - Goderich)

South Huron Hospital (SHH - Exeter)

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* 3. Your clinic visit was to which department?

Diagnostic Imaging (Xray, Ultrasound, Bone Mineral Density, CT, Mammography)

CardioRespiratory (ECG, Stress Test, Pulmonary Function Test, Holter, Blood Pressure Monitoring)

Community Lab (SHH Only)

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* 4. In the last 12 months, how many times (including this one) have you visited this clinic for any condition?

This was the only time

2 or 3 times

4 to 8 times

More than 8 times

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* 5. Did the hospital change your appointment to a later date?

Yes, once

Yes, 2 or 3 times

Yes, 4 times or more

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* 6. Were you given directions to the location of the clinic inside the hospital?

Yes, good directions were given

Yes, I was given directions but needed additional help

Yes, directions were given but I already knew where to go

No directions were given. I had to ask for directions once inside

No directions were given but I already knew where to go

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* 7. Before your appointment, did you know what would happen to you during the appointment?

Definitely

For the most part

Somewhat

Not at all

Don't know/Can't remember

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* 8. If your appointment did not start on time, how many minutes did you have to wait in the waiting room?

I was seen on time, or early

I waited up to 15 minutes

I waited up to 60 minutes

I waited more than 60 minutes

Don't know/Can't remember

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* 9. If you had to wait, were you told why?

Yes

No, but I would have liked a reason

No, but I did not mind

Don't know/Can't remember

I did not have to wait

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* 10. Did the health professionals treating and examining you introduce themselves?

Yes, all of the staff introduced themselves

Some of the staff introduced themselves

Very few or none of the staff introduced themselves

Don't know/Can't remember

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* 11. Did a member of the staff tell you how you would find out the results of your test(s)?

Definitely

For the most part

Somewhat

Not at all

Not sure/Can't remember

I did not need an explanation

Did not have a test

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* 12. Before the tests began, did a health professional explain any risks and/or benefits in a way you could understand?

Definitely

For the most part

Somewhat

Not at all

Don't know/Can't remember

I did not want or need an explanation

I did not have tests

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* 13. Were you given enough privacy during your visit?

Definitely

For the most part

Somewhat

Not at all (please tell us more in the open text box at the end of this survey)

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* 14. Did you receive enough information from hospital staff about what to do if you were concerned about your exam/test after you left the hospital?

Not at all

Partly

Quite a bit

Completely

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* 15. Overall, did you feel you were treated with respect and dignity while you were at the department?

Definitely

For the most part

Somewhat

Not at all

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* 16. Overall...(Please pick a number)

0 I had a very poor experience

10 I had a very good experience

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* 17. What else would you like to say about this outpatient experience? (Please do not include any names, contact information, or identifying information)

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* 18. Is there a staff member or group that you would like to recognize for providing exceptional care or service?

If you have any immediate questions or concerns regarding your experience with us, please contact our Patient Relations Office using the contact information below.