Docs by the Bay Physician Recruitment and Retention

Patient Survey

This survey is for those individuals in Quinte West and Brighton who DO NOT currently have a Family Doctor or Nurse Practitioner (NP). Please note, this information is being collected to help us better understand the number of residents who DO NOT have a Family Doctor/NP. This in NO WAY means you will be assigned to a Family Doctor or NP or any sort of wait list. It is strictly to assist in our Physician Recruitment and Retention efforts.

Question Title

* 1. Do you have a Family Doctor or Nurse Practitioner (NP) within 30 km of your home.

Yes

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* 2. Do you have a Family Doctor or NP more than 30 KM away from you home?

Yes

Question Title

* 3. If you answered YES to Question 2 above - if a
Doctor/NP became available closer to your home, would you switch?

Yes

Question Title

* 4. If you do not have a Family Doctor/NP, how long have you been without?

Less than 1 year

Between 1 and 5 years

Between 5 and 10 years

More than 10 years

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* 5. Have you registered with ?

Health Care Connect

Belleville-Quinte West Community Health Centre

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* 6. If you answered yes to Q5 above, how long have you been on the list?

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* 7. If you answered no to Q5 above, why are you not registered?

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* 8. Are there other family members who live in your household who do not have a Family Doctor/NP? Please provide relationship and age.

Relationship/Age

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* 9. Are you a current Military family?

Yes

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* 10. Are you a Military veteran?

Yes

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* 11. Your age? (Required)

Under 18

18-24

25-34

35-44

45-54

55-64

65+

Docs by the Bay Physician Recruitment and Retention

Patient Survey

Question Title

* 1. Do you have a Family Doctor or Nurse Practitioner (NP) within 30 km of your home.

Question Title

* 2. Do you have a Family Doctor or NP more than 30 KM away from you home?

Question Title

* 3. If you answered YES to Question 2 above - if a
Doctor/NP became available closer to your home, would you switch?

Question Title

* 4. If you do not have a Family Doctor/NP, how long have you been without?

Question Title

* 5. Have you registered with ?

Question Title

* 6. If you answered yes to Q5 above, how long have you been on the list?

Question Title

* 7. If you answered no to Q5 above, why are you not registered?

Question Title

* 8. Are there other family members who live in your household who do not have a Family Doctor/NP? Please provide relationship and age.

Question Title

* 9. Are you a current Military family?

Question Title

* 10. Are you a Military veteran?

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* 11. Your age? (Required)

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* 12. Your Postal Code? (Required)

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* 13. Your name? (Optional)

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* 14. Your email? (Optional)

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* 15. Is there anything further you wish to add.

Docs by the Bay Physician Recruitment and Retention

Patient Survey

Question Title

* 1. Do you have a Family Doctor or Nurse Practitioner (NP) within 30 km of your home.

Question Title

* 2. Do you have a Family Doctor or NP more than 30 KM away from you home?

Question Title

* 3. If you answered YES to Question 2 above - if a Doctor/NP became available closer to your home, would you switch?

Question Title

* 4. If you do not have a Family Doctor/NP, how long have you been without?

Question Title

* 5. Have you registered with ?

Question Title

* 6. If you answered yes to Q5 above, how long have you been on the list?

Question Title

* 7. If you answered no to Q5 above, why are you not registered?

Question Title

* 8. Are there other family members who live in your household who do not have a Family Doctor/NP? Please provide relationship and age.

Question Title

* 9. Are you a current Military family?

Question Title

* 10. Are you a Military veteran?

Question Title

* 11. Your age? (Required)

Question Title

* 12. Your Postal Code? (Required)

Question Title

* 13. Your name? (Optional)

Question Title

* 14. Your email? (Optional)

Question Title

* 15. Is there anything further you wish to add.

* 3. If you answered YES to Question 2 above - if a
Doctor/NP became available closer to your home, would you switch?