Patient Experience Survey

You are being invited to take part in this survey because you have recently had a visit to a health care facility affiliated with Northumberland Family Health Team. Your responses will help us improve the care we provide. There are 24 questions in the survey and it should take approximately 5 minutes to complete. Participation in the survey is completely voluntary and all of your responses to the survey questions will be kept confidential.

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* 1. At which location do you see your doctor?

Cobourg Medical Centre, Burnham Street

Cobourg Health Centre, King Street

Cobourg Clinic, University Avenue

Cobourg Clinic, Division Street

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* 2. When completing this survey which location are you using to base your answers?

Cobourg Medical Centre, Burnham Street

Cobourg Health Centre, King Street

Cobourg Clinic, University Avenue

Cobourg Clinic, Division Street

Northumberland Family Health Team, Northumberland Mall

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* 3. Are you completing this survey for yourself or for another person?

I am completing this survey for myself

I am completing this survey for another person

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* 4. If you are completing this survey for someone else, who are you completing it for?

I am completing this for a family member or friend

I am completing this for a patient or client

Other

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* 5. How was the appointment for your most recent visit made?

I didn't have an appointment - I just dropped in (skip to question Q6b)

I called and set it up

I emailed and set it up

I set it up at my last visit

You called me to set it up

Other

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* 6. Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the following ?

	Poor	Fair	Good	Very Good	Excellent
The length of time it took between making your appointment and the visit you just had	The length of time it took between making your appointment and the visit you just had Poor	The length of time it took between making your appointment and the visit you just had Fair	The length of time it took between making your appointment and the visit you just had Good	The length of time it took between making your appointment and the visit you just had Very Good	The length of time it took between making your appointment and the visit you just had Excellent
Your overall experience accessing the office/clinic	Your overall experience accessing the office/clinic Poor	Your overall experience accessing the office/clinic Fair	Your overall experience accessing the office/clinic Good	Your overall experience accessing the office/clinic Very Good	Your overall experience accessing the office/clinic Excellent

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* 7. On a scale of poor to excellent, how would you rate the following?

	Poor	Fair	Good	Very Good	Excellent
The length of time you had to wait in the reception/waiting area	The length of time you had to wait in the reception/waiting area Poor	The length of time you had to wait in the reception/waiting area Fair	The length of time you had to wait in the reception/waiting area Good	The length of time you had to wait in the reception/waiting area Very Good	The length of time you had to wait in the reception/waiting area Excellent
Your overall experience with our reception staff	Your overall experience with our reception staff Poor	Your overall experience with our reception staff Fair	Your overall experience with our reception staff Good	Your overall experience with our reception staff Very Good	Your overall experience with our reception staff Excellent
The length of time you had to wait in the examination room before you spoke with the health care provider about the reason for your visit	The length of time you had to wait in the examination room before you spoke with the health care provider about the reason for your visit Poor	The length of time you had to wait in the examination room before you spoke with the health care provider about the reason for your visit Fair	The length of time you had to wait in the examination room before you spoke with the health care provider about the reason for your visit Good	The length of time you had to wait in the examination room before you spoke with the health care provider about the reason for your visit Very Good	The length of time you had to wait in the examination room before you spoke with the health care provider about the reason for your visit Excellent

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* 8. Thinking about the MAIN health care provider you spoke with during the visit, on a scale of poor to excellent, how would you rate this person on the following?

	Poor	Fair	Good	Very Good	Excellent
They knew about your medical history	They knew about your medical history Poor	They knew about your medical history Fair	They knew about your medical history Good	They knew about your medical history Very Good	They knew about your medical history Excellent
They listened to your concerns	They listened to your concerns Poor	They listened to your concerns Fair	They listened to your concerns Good	They listened to your concerns Very Good	They listened to your concerns Excellent
They spoke using a language you could understand	They spoke using a language you could understand Poor	They spoke using a language you could understand Fair	They spoke using a language you could understand Good	They spoke using a language you could understand Very Good	They spoke using a language you could understand Excellent
They explained things in a way that was easy to understand	They explained things in a way that was easy to understand Poor	They explained things in a way that was easy to understand Fair	They explained things in a way that was easy to understand Good	They explained things in a way that was easy to understand Very Good	They explained things in a way that was easy to understand Excellent
They were sensitive to your needs and preferences	They were sensitive to your needs and preferences Poor	They were sensitive to your needs and preferences Fair	They were sensitive to your needs and preferences Good	They were sensitive to your needs and preferences Very Good	They were sensitive to your needs and preferences Excellent
They treated you with dignity and respect	They treated you with dignity and respect Poor	They treated you with dignity and respect Fair	They treated you with dignity and respect Good	They treated you with dignity and respect Very Good	They treated you with dignity and respect Excellent
They gave you clear instructions about what you need to do after your visit	They gave you clear instructions about what you need to do after your visit Poor	They gave you clear instructions about what you need to do after your visit Fair	They gave you clear instructions about what you need to do after your visit Good	They gave you clear instructions about what you need to do after your visit Very Good	They gave you clear instructions about what you need to do after your visit Excellent
Your overall experience speaking with the health care provider about the reason for your visit	Your overall experience speaking with the health care provider about the reason for your visit Poor	Your overall experience speaking with the health care provider about the reason for your visit Fair	Your overall experience speaking with the health care provider about the reason for your visit Good	Your overall experience speaking with the health care provider about the reason for your visit Very Good	Your overall experience speaking with the health care provider about the reason for your visit Excellent

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* 9. Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the following?

	Poor	Fair	Good	Very Good	Excellent
The overall cleanliness of the office/clinic	The overall cleanliness of the office/clinic Poor	The overall cleanliness of the office/clinic Fair	The overall cleanliness of the office/clinic Good	The overall cleanliness of the office/clinic Very Good	The overall cleanliness of the office/clinic Excellent
The overall physical comfort of the office/clinic	The overall physical comfort of the office/clinic Poor	The overall physical comfort of the office/clinic Fair	The overall physical comfort of the office/clinic Good	The overall physical comfort of the office/clinic Very Good	The overall physical comfort of the office/clinic Excellent
Your confidence in the doctor/health care provider(s) you saw during the visit	Your confidence in the doctor/health care provider(s) you saw during the visit Poor	Your confidence in the doctor/health care provider(s) you saw during the visit Fair	Your confidence in the doctor/health care provider(s) you saw during the visit Good	Your confidence in the doctor/health care provider(s) you saw during the visit Very Good	Your confidence in the doctor/health care provider(s) you saw during the visit Excellent
Your confidence that your health information was treated with the level of privacy you expect	Your confidence that your health information was treated with the level of privacy you expect Poor	Your confidence that your health information was treated with the level of privacy you expect Fair	Your confidence that your health information was treated with the level of privacy you expect Good	Your confidence that your health information was treated with the level of privacy you expect Very Good	Your confidence that your health information was treated with the level of privacy you expect Excellent
Your overall experience with the visit you had with us	Your overall experience with the visit you had with us Poor	Your overall experience with the visit you had with us Fair	Your overall experience with the visit you had with us Good	Your overall experience with the visit you had with us Very Good	Your overall experience with the visit you had with us Excellent

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* 10. The last time you were sick or were concerned you had a health problem ....

	Yes	No
Did you get an appointment on the date you wanted	Did you get an appointment on the date you wanted Yes	Did you get an appointment on the date you wanted No

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* 11. 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?

Same day

Next day

2-19 days

20 or more days

Not applicable (don't know/refused)

Same day

Next day

2-19 days

20 or more days

Not applicable (don't know/refused)

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* 12. When you see your doctor or nurse practitioner, how often do they or someone else in the office ..?

	Never	Rarely	Sometimes	Often	Always
a. Give you an opportunity to ask questions about recommended treatment	a. Give you an opportunity to ask questions about recommended treatment Never	a. Give you an opportunity to ask questions about recommended treatment Rarely	a. Give you an opportunity to ask questions about recommended treatment Sometimes	a. Give you an opportunity to ask questions about recommended treatment Often	a. Give you an opportunity to ask questions about recommended treatment Always
b. Involve you as much as you want to be in decisions about your care and treatment	b. Involve you as much as you want to be in decisions about your care and treatment Never	b. Involve you as much as you want to be in decisions about your care and treatment Rarely	b. Involve you as much as you want to be in decisions about your care and treatment Sometimes	b. Involve you as much as you want to be in decisions about your care and treatment Often	b. Involve you as much as you want to be in decisions about your care and treatment Always
c. Spend enough time with you	c. Spend enough time with you Never	c. Spend enough time with you Rarely	c. Spend enough time with you Sometimes	c. Spend enough time with you Often	c. Spend enough time with you Always

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* 13. Over the last year or so ......

	Yes ( Go to Q14)	NO (Skip to Q15)
Did you receive care from a health care provider (s) at a location other than this practice	Did you receive care from a health care provider (s) at a location other than this practice Yes ( Go to Q14)	Did you receive care from a health care provider (s) at a location other than this practice NO (Skip to Q15)

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* 14. Thinking about the health care(s) providers that you have seen at the different places you have received care over the last year or so, how often ...?

	Never	Rarely	Sometimes	Often	Always
Did each seem to know your medical history	Did each seem to know your medical history Never	Did each seem to know your medical history Rarely	Did each seem to know your medical history Sometimes	Did each seem to know your medical history Often	Did each seem to know your medical history Always
Did each seem to have your recent tests or exam results	Did each seem to have your recent tests or exam results Never	Did each seem to have your recent tests or exam results Rarely	Did each seem to have your recent tests or exam results Sometimes	Did each seem to have your recent tests or exam results Often	Did each seem to have your recent tests or exam results Always
Were they consistent in what they were telling you about your care and treatment?	Were they consistent in what they were telling you about your care and treatment? Never	Were they consistent in what they were telling you about your care and treatment? Rarely	Were they consistent in what they were telling you about your care and treatment? Sometimes	Were they consistent in what they were telling you about your care and treatment? Often	Were they consistent in what they were telling you about your care and treatment? Always
Did they seem to work well together in caring for you	Did they seem to work well together in caring for you Never	Did they seem to work well together in caring for you Rarely	Did they seem to work well together in caring for you Sometimes	Did they seem to work well together in caring for you Often	Did they seem to work well together in caring for you Always

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* 15. On another issue, the last time when you needed medical care in the evening, on the weekend, or on a public holiday, how easy was it to get care without going to the emergency department?

Very Difficult

Somewhat Difficult

Somewhat Easy

Very Easy

Not applicable

Very Difficult

Somewhat Difficult

Somewhat Easy

Very Easy

Not applicable

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* 16. In general how would you rate your overall health?

Poor

Fair

Good

Very Good

Excellent

Poor

Fair

Good

Very Good

Excellent

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* 17. How long have you been visiting us for your health care?

Less than six months

Between six months and a year

Between one and three years

Between three and five years

Longer than five years

Less than six months

Between six months and a year

Between one and three years

Between three and five years

Longer than five years

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* 18. Using your best guess, how many times did you visit us over the last year or so for your own medical care?

One

Two

Three

Four

Five or more

One

Two

Three

Four

Five or more

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* 19. Would you recommend our services to your family or friends? Check ONE only.

Definitely no

Probably no

Probably yes

Definitely yes

Definitely no

Probably no

Probably yes

Definitely yes

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* 1. At which location do you see your doctor?

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* 2. When completing this survey which location are you using to base your answers?

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* 3. Are you completing this survey for yourself or for another person?

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* 4. If you are completing this survey for someone else, who are you completing it for?

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* 5. How was the appointment for your most recent visit made?

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* 6. Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the following ?

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* 7. On a scale of poor to excellent, how would you rate the following?

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* 8. Thinking about the MAIN health care provider you spoke with during the visit, on a scale of poor to excellent, how would you rate this person on the following?

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* 9. Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the following?

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* 10. The last time you were sick or were concerned you had a health problem ....

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* 11. 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?

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* 12. When you see your doctor or nurse practitioner, how often do they or someone else in the office ..?

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* 13. Over the last year or so ......

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* 14. Thinking about the health care(s) providers that you have seen at the different places you have received care over the last year or so, how often ...?

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* 15. On another issue, the last time when you needed medical care in the evening, on the weekend, or on a public holiday, how easy was it to get care without going to the emergency department?

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* 16. In general how would you rate your overall health?

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* 17. How long have you been visiting us for your health care?

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* 18. Using your best guess, how many times did you visit us over the last year or so for your own medical care?

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* 19. Would you recommend our services to your family or friends? Check ONE only.

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* 20. If you would like to provide additional feedback, please use the space below:

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* 21. What things do we do well?

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* 22. What things could we improve on?

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* 23. What are topics you would be interested in for a workshop or program?

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* 24. What time of day would work best for workshops or program visits?