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.

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

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

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

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

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

* 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
Your overall experience accessing the office/clinic

* 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
Your overall experience with our reception staff
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

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

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

* 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

* 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?

* 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
b. Involve you as much as you want to be in decisions about your care and treatment
c. Spend enough time with you

* 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

* 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 have your recent tests or exam results
Were they consistent in what they were telling you about your care and treatment?
Did they seem to work well together in caring for you

* 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?

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

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

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

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

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

* 21. What things do we do well?

* 22. What things could we improve on?

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

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

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