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

Your responses to the questions on this survey will help us improve the care and programs we provide. Participation in this survey is completely voluntary and all your responses to the survey questions will be kept confidential.

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* 1. First & Last Name (Optional)

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* 2. Phone Number (Optional)

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* 3. Email (Optional)

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* 4. Address (Optional)

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* 5. Please identify the community/clinic you attended

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* 6. Feedback: Compliments/Concerns:

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* 7. I. Who did you see today?

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* 8. The last day you were sick or concerned you had a health problem; did you get an appointment on the date that you wanted?

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* 9. Did you request a same day/next day appointment?

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* 10. If you requested a same day/next day appointment, did you receive one?

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* 11. I feel comfortable and welcome at the centre/office.

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* 12. When you see your doctor or nurse practitioner, how often do they or someone else in the office involve you as much as you want to be in the decisions about your care and treatment?

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