Screen Reader Mode Icon
EXIT

Question Title

* 1. Are you completing this survey for:

Question Title

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

Question Title

* 3. If you have visited the clinic in the last 12 months, were there times when you: (check all that apply)

Question Title

* 4. How did you book your last appointment?

Question Title

* 5. Thinking of the last time you were sick or concerned about a health issue, did you get an appointment as soon as you wanted?

Question Title

* 6. Thinking of the last time you were sick or concerned about a health issue, was your appointment for:

Question Title

* 7. Thinking of the the last time you were sick or concerned about a health issue, how many days did you wait for your appointment?

Question Title

* 8. Thinking about the MAIN healthcare provider you spoke with during the visit, on a scale of poor to excellent, how would you rate this person on how well they knew your medical history?

Question Title

* 9. Thinking about the MAIN healthcare provider you spoke with during the visit, on a scale of poor to excellent, how would you rate this person on how well they listened to your concerns?

Question Title

* 10. Thinking about the MAIN healthcare provider you spoke with during the visit, on a scale of poor to excellent, how would you rate this person on using language that you could understand?

Question Title

* 11. Thinking about the MAIN healthcare provider you spoke with during the visit, on a scale of poor to excellent, how would you rate this person on how well they explained things in a way that was easy to understand?

Question Title

* 12. Thinking about the MAIN healthcare provider you spoke with during the visit, on a scale of poor to excellent, how would you rate this person on how sensitive they were to your needs and preferences?

Question Title

* 13. Thinking about the MAIN healthcare provider you spoke with during the visit, on a scale of poor to excellent, how would you rate this person on how they treated you with dignity and respect?

Question Title

* 14. Thinking about the MAIN healthcare provider you spoke with during the visit, on a scale of poor to excellent, how would you rate this person on whether or not they gave you clear instructions about what to do after your visit?

Question Title

* 15. Thinking about the MAIN healthcare provider you spoke with during the visit, on a scale of poor to excellent, how would you rate this person on your overall experience with them?

Question Title

* 16. When you visited the clinic, were you included in the decisions about your care?

Question Title

* 17. Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the cleanliness of the clinic.

Question Title

* 18. Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the physical comfort of the clinic.

Question Title

* 19. Thinking about your most recent visit, on a scale of poor to excellent, how would you rate your confidence in the healthcare providers.

Question Title

* 20. Thinking about your most recent visit, on a scale of poor to excellent, how would you rate your confidence that your health information was treated confidentially.

Question Title

* 21. Thinking about your most recent visit, on a scale of poor to excellent, how would you rate your overall experience with the visit you had with us.

Question Title

* 22. How satisfied are you with the service by the receptionists and staff at the clinic?

Question Title

* 23. Are you aware of the additional programs and services at our clinic? (ie. Footcare, Diabetes education and support programs, health eating counselling, mental health counselling, insomnia program, smoking cessation program, anxiety and depression group, cardio-pulmonary rehab program)

Question Title

* 24. How satisfied are you with the programs and services offered at the clinic?

Question Title

* 25. Are there other services or programs you would like to see?

Question Title

* 26. In the past 12 months, have you taken one or more prescription medications on a regular basis?

Question Title

* 27. If yes to Question 26, did someone review the prescription medications with you?

Question Title

* 28. If yes to Question 27, please indicate whom it was with:

Question Title

* 29. Optional Feedback: If you would like to provide additional feedback, please use the space below.  Also keeping in mind that the survey is completely anonymous, and you are comfortable letting us know who your healthcare provider is, please indicate below.

Question Title

* 30. Thinking of your overall experience with your clinic, what are two (2) things we do well?

Question Title

* 31. Thinking of your overall experience with your clinic, what are two (2) things we could improve upon?

Question Title

* 32. My healthcare provider is:

0 of 32 answered
 

T