Leeds & Grenville Community FHT Patient Experience Survey

Thank you for taking the time to complete our survey. The answers that you provide will be used to improve our services and better understand the needs of our patients. This survey is completely confidential and anonymous. Your opinion really matters to us!

* 1) What is your gender:

* 2) What is your age?

* 3) How is your health (in general)?

* 4) Who is your family doctor? (This is the doctor you signed a roster form with when you joined the FHT).

* 5A) The last time you were sick or were concerned you had a health problem, how many days did it take from when you first tried to see your doctor or nurse practitioner to when you actually SAW him/her or someone else in their office?

* 5B) If you answered 2-19 days, please tell us how many days it took:

* 5C) If it took more than 2 days to be seen by a provider when you were sick or were concerned you had a health problem, please explain why:

* 6) When you book an appointment at our office, do you feel that the appointment date offered to you was within a reasonable amount of time?

* 7) 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?

* 8) When making an appointment or contacting the office, how would you rate your experience with the reception desk and office staff?

* 9) Is there anything else you would like to comment on?
This can be a memorable experience (positive or constructive) you have had with a provider/staff member, or anything you would like to share with us.

* For our tracking and quality improvement purposes, can you please let us know what month you completed this survey in?

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