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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.
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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
