Well Woman Program - Patient Feedback

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* 1. Does the Well Woman Program meet your needs?

1 - No

3 - Sometimes

5 - Yes

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 2. Beyond your cervical cancer screening test every three years, what aspect of the Well Woman Program is most useful to you? Please check one.

Birth control advice

Menopause information and support

Sexually transmitted infections testing and information

Hormone replacement information and support

Nutrition information and support

Bone density testing

Physiotherapy services for osteoporosis

General women’s health advice

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* 3. How well were you able to understand all of the information presented to you at your appointment?

1 - Not at all

3 - Somewhat understood

5 - Understood all

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 4. Do you feel that your questions were acknowledged and answered?

1 - No

3 - Sometimes

5 - Yes

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 5. How long have you been coming to the Well Woman Program?

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* 6. How often do you come to the Well Woman Program? (Check one of the following.)

Twice a Year

Annually

Every 3 years

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* 7. Please check all the following family health team services you have accessed to support your personal health.

Dietitian

Pharmacist

Mental Health

Physiotherapy

Diabetes Management

Chronic Pain Assessment

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* 8. What do you like about the Well Woman Program?

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* 9. What one thing would you improve about the Well Woman Program?

Thank you!

If you have any questions or concerns, please contact

Portage Medical Family Health Team Executive Director,

Carol Stewart-Kirkby - 905-354-9393, ext. 222

carol.stewart-kirkby@portagemedicalfht.ca