Instructions

Thank you for taking the time to complete this questionnaire. It will take about 10 minutes to complete. All of the questions are important. Please try to answer them all by ticking the appropriate box. Your answers will be kept strictly confidential and anonymous.

We are looking for your feedback on your experiences as a patient and how your doctor communicated with you. 


We would like you to think back to your last visit to a doctor while the completing the questions below.

What type of appointment was this?

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* 1. We would like you to think back to your last visit to a doctor while the completing the questions below.

What type of appointment was this?

How long were you waiting to see the doctor?

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* 2. How long were you waiting to see the doctor?

Did you see the doctor on your own?

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* 3. Did you see the doctor on your own?

Did the doctor introduce themselves to you?

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* 4. Did the doctor introduce themselves to you?

What type of Doctor did you meet today at your appointment?

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* 5. What type of Doctor did you meet today at your appointment?

Was there a nurse present during your
appointment?

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* 6. Was there a nurse present during your
appointment?

I had sufficient length of time for my consultation?

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* 7. I had sufficient length of time for my consultation?

Were you asked if you wanted to ask any questions?

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* 8. Were you asked if you wanted to ask any questions?

Did you ask any questions?

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* 9. Did you ask any questions?

Did you plan what questions you wanted to ask before your appointment?

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* 10. Did you plan what questions you wanted to ask before your appointment?

I felt the Doctor listened to me during my appointment

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* 11. I felt the Doctor listened to me during my appointment

The Doctor took my opinion into account

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* 12. The Doctor took my opinion into account

I experienced the consultation as a two way conversation

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* 13. I experienced the consultation as a two way conversation

The doctor used language I could understand

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* 14. The doctor used language I could understand

The doctor’s body language (gesture, eye contact, mannerisms and tone of voice) throughout the appointment was appropriate

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* 15. The doctor’s body language (gesture, eye contact, mannerisms and tone of voice) throughout the appointment was appropriate

I have a good understanding of the next steps of my care after today’s appointment (for example when my next appointment, scan, blood test is etc?)

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* 16. I have a good understanding of the next steps of my care after today’s appointment (for example when my next appointment, scan, blood test is etc?)

Were you given the name and contact details of someone to contact if you have any questions after your appointment?

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* 17. Were you given the name and contact details of someone to contact if you have any questions after your appointment?

Do you feel confident to contact that person?

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* 18. Do you feel confident to contact that person?

On a scale from 1 to 10, how satisfied were you with the overall communication with the Doctor? (10 = very satisfied)

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* 19. On a scale from 1 to 10, how satisfied were you with the overall communication with the Doctor? (10 = very satisfied)

If there is something else that you would like to tell us about your appointment, please use the space below:

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* 20. If there is something else that you would like to tell us about your appointment, please use the space below:

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