Patient Satisfaction Survey

It is our goal to meet your health care needs and provide the best possible service. Please answer this questionnaire to tell us what we are doing well and where we need to improve. All responses will be kept confidential and anonymous.

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* 1. Have you completed this survey in the last 12 months?

Yes

No

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* 2. Considering your most recent appointment, how did you connect with your provider?

Telephone

Video conference (e.g. OTN or doxy.me)

In-person

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* 3. How many days did it take from when you called to make an appointment to when you actually had your appointment with your doctor, or a nurse practitioner (including virtual appointments)?

Same day

Next day

2-19 days

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* 4. When you telephoned the clinic, were you hoping to be seen by your doctor that day (virtual or in-person)?

Yes

No

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* 5. Did you feel the number of days you had to wait for an appointment (including virtual appointments) was reasonable?

Yes

No

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* 6. When you see your doctor or nurse practitioner (virtual or in-person), how often do they or someone else in their office:

	Always	Usually	Half of the time	Hardly ever	Never
a) Give you the opportunity to ask questions about recommended care and/or treatment?	a) Give you the opportunity to ask questions about recommended care and/or treatment? Always	a) Give you the opportunity to ask questions about recommended care and/or treatment? Usually	a) Give you the opportunity to ask questions about recommended care and/or treatment? Half of the time	a) Give you the opportunity to ask questions about recommended care and/or treatment? Hardly ever	a) Give you the opportunity to ask questions about recommended care and/or treatment? Never
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? Always	b) Involve you as much as you want to be in decisions about your care and treatment? Usually	b) Involve you as much as you want to be in decisions about your care and treatment? Half of the time	b) Involve you as much as you want to be in decisions about your care and treatment? Hardly ever	b) Involve you as much as you want to be in decisions about your care and treatment? Never

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* 7. Thinking about your most recent visit (virtual or in-person), on a scale of excellent to poor please rate the following:

	Excellent	Very good	Good	Okay	Poor	Not applicable
a. Your satisfaction with how well your care provider listened to your concerns?	a. Your satisfaction with how well your care provider listened to your concerns? Excellent	a. Your satisfaction with how well your care provider listened to your concerns? Very good	a. Your satisfaction with how well your care provider listened to your concerns? Good	a. Your satisfaction with how well your care provider listened to your concerns? Okay	a. Your satisfaction with how well your care provider listened to your concerns? Poor	a. Your satisfaction with how well your care provider listened to your concerns? Not applicable
b. Your satisfaction with how much your care provider seemed concerned about your feelings?	b. Your satisfaction with how much your care provider seemed concerned about your feelings? Excellent	b. Your satisfaction with how much your care provider seemed concerned about your feelings? Very good	b. Your satisfaction with how much your care provider seemed concerned about your feelings? Good	b. Your satisfaction with how much your care provider seemed concerned about your feelings? Okay	b. Your satisfaction with how much your care provider seemed concerned about your feelings? Poor	b. Your satisfaction with how much your care provider seemed concerned about your feelings? Not applicable
c. Your satisfaction with how courteous and helpful the person who scheduled your appointment was?	c. Your satisfaction with how courteous and helpful the person who scheduled your appointment was? Excellent	c. Your satisfaction with how courteous and helpful the person who scheduled your appointment was? Very good	c. Your satisfaction with how courteous and helpful the person who scheduled your appointment was? Good	c. Your satisfaction with how courteous and helpful the person who scheduled your appointment was? Okay	c. Your satisfaction with how courteous and helpful the person who scheduled your appointment was? Poor	c. Your satisfaction with how courteous and helpful the person who scheduled your appointment was? Not applicable
d. Your satisfaction with the quality of health information available to you in our waiting room	d. Your satisfaction with the quality of health information available to you in our waiting room Excellent	d. Your satisfaction with the quality of health information available to you in our waiting room Very good	d. Your satisfaction with the quality of health information available to you in our waiting room Good	d. Your satisfaction with the quality of health information available to you in our waiting room Okay	d. Your satisfaction with the quality of health information available to you in our waiting room Poor	d. Your satisfaction with the quality of health information available to you in our waiting room Not applicable
e. Your satisfaction with the length of time you had to wait in the reception area prior to seeing your care provider	e. Your satisfaction with the length of time you had to wait in the reception area prior to seeing your care provider Excellent	e. Your satisfaction with the length of time you had to wait in the reception area prior to seeing your care provider Very good	e. Your satisfaction with the length of time you had to wait in the reception area prior to seeing your care provider Good	e. Your satisfaction with the length of time you had to wait in the reception area prior to seeing your care provider Okay	e. Your satisfaction with the length of time you had to wait in the reception area prior to seeing your care provider Poor	e. Your satisfaction with the length of time you had to wait in the reception area prior to seeing your care provider Not applicable
f. Your satisfaction with how long you waited to speak with a receptionist when you booked your appointment.	f. Your satisfaction with how long you waited to speak with a receptionist when you booked your appointment. Excellent	f. Your satisfaction with how long you waited to speak with a receptionist when you booked your appointment. Very good	f. Your satisfaction with how long you waited to speak with a receptionist when you booked your appointment. Good	f. Your satisfaction with how long you waited to speak with a receptionist when you booked your appointment. Okay	f. Your satisfaction with how long you waited to speak with a receptionist when you booked your appointment. Poor	f. Your satisfaction with how long you waited to speak with a receptionist when you booked your appointment. Not applicable
g. Your overall satisfaction with your experience as a patient of this medical clinic	g. Your overall satisfaction with your experience as a patient of this medical clinic Excellent	g. Your overall satisfaction with your experience as a patient of this medical clinic Very good	g. Your overall satisfaction with your experience as a patient of this medical clinic Good	g. Your overall satisfaction with your experience as a patient of this medical clinic Okay	g. Your overall satisfaction with your experience as a patient of this medical clinic Poor	g. Your overall satisfaction with your experience as a patient of this medical clinic Not applicable

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* 8. Have you visited the clinic’s NEW website www.cbfht.ca in the past 3 months?

Yes

No

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* 9. Did you find any of the health information in the waiting room of interest/applicable to you?

Yes

No

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* 10. Stay up to date with all of our news and events! Subscribe to our mailing list by leaving your e-mail below. (*Note: this is not a communication tool used to discuss confidential medical information only promotional material. You can unsubscribe at any time)