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* 1. Which of the following is your primary care provider?

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* 2. In the past 12 months, 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 decisions about your care and treatment?

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* 3. In the past 12 months, when you consulted an allied health provider at the Nord-Aski Family Health Team, did you feel you were sufficiently involved in the decisions regarding your healthcare? (Nurse, Mental Health Counsellor, Dietitian, Patient Navigator and First Nation Liaison)

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* 4. How would you rate the following elements?

  Poor Fair Good Very Good Excellent
Experience before your appointment (reception, wait time in reception or exam room, etc.)
Experience during your appointment (feeling respected, understood, etc.)
Experience after your appointment (follow-up, lab results, etc.)

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* 5. Please provide any additional comment in the box below:

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* 6. I always feel comfortable and welcome at Nord-Aski Family Health Team

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* 7. Overall, how would you rate your experience with our Physician Group or Family Health Team?

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