Satisfaction Questionnaire

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Question Title

* 1. Prior to the procedure:

	YES	NO
In your opinion, was the test done quickly enough after you were referred to the clinic?	In your opinion, was the test done quickly enough after you were referred to the clinic? YES	In your opinion, was the test done quickly enough after you were referred to the clinic? NO
Did you feel you had access to enough information (web site, clinic staff) to make you feel informed about the test?	Did you feel you had access to enough information (web site, clinic staff) to make you feel informed about the test? YES	Did you feel you had access to enough information (web site, clinic staff) to make you feel informed about the test? NO
Did you feel that everything was explained/presented in a clear, comprehensible manner?	Did you feel that everything was explained/presented in a clear, comprehensible manner? YES	Did you feel that everything was explained/presented in a clear, comprehensible manner? NO
Did you feel that you had received enough information to properly prepare for the test?	Did you feel that you had received enough information to properly prepare for the test? YES	Did you feel that you had received enough information to properly prepare for the test? NO

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* 2. The day of the Procedure

	YES	NO
Did the nurse or doctor discuss what the test involved?	Did the nurse or doctor discuss what the test involved? YES	Did the nurse or doctor discuss what the test involved? NO
Did the nurse or doctor mention that, although it happens very rarely, there might be risks of doing the test (complications such as bleeding or perforation)?	Did the nurse or doctor mention that, although it happens very rarely, there might be risks of doing the test (complications such as bleeding or perforation)? YES	Did the nurse or doctor mention that, although it happens very rarely, there might be risks of doing the test (complications such as bleeding or perforation)? NO
Before going in for the procedure, did you feel that you had an opportunity to ask the nurses any further questions you may have had?	Before going in for the procedure, did you feel that you had an opportunity to ask the nurses any further questions you may have had? YES	Before going in for the procedure, did you feel that you had an opportunity to ask the nurses any further questions you may have had? NO
In the procedure room, did you feel that you had an opportunity to ask the doctor doing the test any further questions you may have had?	In the procedure room, did you feel that you had an opportunity to ask the doctor doing the test any further questions you may have had? YES	In the procedure room, did you feel that you had an opportunity to ask the doctor doing the test any further questions you may have had? NO
Do you feel that you had adequate time in the procedure room and that you and the doctor doing the test were not rushed?	Do you feel that you had adequate time in the procedure room and that you and the doctor doing the test were not rushed? YES	Do you feel that you had adequate time in the procedure room and that you and the doctor doing the test were not rushed? NO
Was the doctor doing the test courteous and considerate?	Was the doctor doing the test courteous and considerate? YES	Was the doctor doing the test courteous and considerate? NO
Were the nurses assisting with the test courteous and considerate?	Were the nurses assisting with the test courteous and considerate? YES	Were the nurses assisting with the test courteous and considerate? NO
Was the test more uncomfortable than you thought it would be?	Was the test more uncomfortable than you thought it would be? YES	Was the test more uncomfortable than you thought it would be? NO

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* 3. At the clinic

	YES	NO
Was your journey through the clinic well coordinated?	Was your journey through the clinic well coordinated? YES	Was your journey through the clinic well coordinated? NO
Were you treated courteously and with respect?	Were you treated courteously and with respect? YES	Were you treated courteously and with respect? NO
Did you feel adequately informed about what was happening to you and when?	Did you feel adequately informed about what was happening to you and when? YES	Did you feel adequately informed about what was happening to you and when? NO
Were you comfortable when waiting for the test?	Were you comfortable when waiting for the test? YES	Were you comfortable when waiting for the test? NO
Was there an excessive delay in waiting for your test?	Was there an excessive delay in waiting for your test? YES	Was there an excessive delay in waiting for your test? NO

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* 4. Privacy and Dignity
We appreciate that many people will feel that these tests do invade their privacy and are not always very dignified. But within these limits:

	YES	NO
Did you feel that your privacy was respected as best as it could be?	Did you feel that your privacy was respected as best as it could be? YES	Did you feel that your privacy was respected as best as it could be? NO
Did you feel that attempts were made to preserve your dignity?	Did you feel that attempts were made to preserve your dignity? YES	Did you feel that attempts were made to preserve your dignity? NO

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* 5. Aftercare

	YES	NO
Were you given information on what reactions to expect after your procedure?	Were you given information on what reactions to expect after your procedure? YES	Were you given information on what reactions to expect after your procedure? NO
Did a doctor/nurse explain your preliminary findings?	Did a doctor/nurse explain your preliminary findings? YES	Did a doctor/nurse explain your preliminary findings? NO
Did you receive a written copy of your preliminary findings and post-procedure instructions?	Did you receive a written copy of your preliminary findings and post-procedure instructions? YES	Did you receive a written copy of your preliminary findings and post-procedure instructions? NO
Are you satisfied with the way your results were communicated to you?	Are you satisfied with the way your results were communicated to you? YES	Are you satisfied with the way your results were communicated to you? NO
Were you given information regarding the follow-up of your care? (i.e. if follow-up was required, who would see you in follow up and when?)	Were you given information regarding the follow-up of your care? (i.e. if follow-up was required, who would see you in follow up and when?) YES	Were you given information regarding the follow-up of your care? (i.e. if follow-up was required, who would see you in follow up and when?) NO

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* 6. What was your overall assessment of the procedure?

Extremely tolerable

Tolerable

Fairly tolerable

Do not remember

Extremely intolerable

Fairly intolerable

Intolerable

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* 7. How did your experience of the test compare with the expectations you had prior to the test?

The experience of the test was exactly as I had expected it to be

The experience of the test was worse than I had expected

The experience of the test was better than I had expected

Do not remember

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* 8. Would you be willing to undergo the same test in the future if your doctor recommended it?

I would have it again if necessary

I would only have it again if essential

I would not have the procedure again

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* 9. Please compare your experience here to your previous colonoscopy experiences:

	YES	NO	N/A
More positive than the same procedure in a hospital setting	More positive than the same procedure in a hospital setting YES	More positive than the same procedure in a hospital setting NO	More positive than the same procedure in a hospital setting N/A
More positive than the same procedure in a different out-of-hospital clinic	More positive than the same procedure in a different out-of-hospital clinic YES	More positive than the same procedure in a different out-of-hospital clinic NO	More positive than the same procedure in a different out-of-hospital clinic N/A

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* 1. Prior to the procedure:

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* 2. The day of the Procedure

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* 3. At the clinic

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* 4. Privacy and DignityWe appreciate that many people will feel that these tests do invade their privacy and are not always very dignified. But within these limits:

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* 5. Aftercare

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* 6. What was your overall assessment of the procedure?

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* 7. How did your experience of the test compare with the expectations you had prior to the test?

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* 8. Would you be willing to undergo the same test in the future if your doctor recommended it?

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* 9. Please compare your experience here to your previous colonoscopy experiences:

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* 10. Comments? (If you would like to be contacted by one of our staff members to discuss your comments, please include your contact information.)

* 4. Privacy and Dignity
We appreciate that many people will feel that these tests do invade their privacy and are not always very dignified. But within these limits: