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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. 

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

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

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

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

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* 5. Have you registered with ?

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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.

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* 9. Are you a current Military family?

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* 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.

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