Skip to content
Check Screen Reader Mode to make this survey compatible with screen readers.
Check Screen Reader Mode to make this survey compatible with screen readers.
PEFHT Memory Clinic Feedback Survey 2026
Please identify the words that best describe your feelings at each stage, or type in your own words.
OK
*
1.
I am:
(Required.)
A Memory Clinic patient.
Care Partner / Family Member of a Memory Clinic patient.
*
2.
I have a better understanding about the symptoms / condition as a result of todays visit.
(Required.)
Strongly Disagree
1 smiley
Disagree
2 smileys
Neutral
3 smileys
Agree
4 smileys
Strongly Agree
5 smileys
*
3.
My questions were answered at this appointment.
(Required.)
Strongly Disagree
1 smiley
Disagree
2 smileys
Neutral
3 smileys
Agree
4 smileys
Strongly Agree
5 smileys
*
4.
I was given enough information about recommendations, available services and supports.
(Required.)
Strongly Disagree
1 smiley
Disagree
2 smileys
Neutral
3 smileys
Agree
4 smileys
Strongly Agree
5 smileys
*
5.
The visit to the Memory Clinic was a valuable addition to the regular care provided by my family doctor / nurse practitioner.
(Required.)
Strongly Disagree
1 smiley
Disagree
2 smileys
Neutral
3 smileys
Agree
4 smileys
Strongly Agree
5 smileys
*
6.
Are there any other comments you would like to make about today's visit?
(Required.)
Current Progress,
0 of 6 answered
