Thank you for taking the time to answer this short survey about your care as a patient at this practice. Please note that your answers will be kept confidential. Your name will not be collected. It will not be possible to identify who completed a survey and who did not.

* 1. Please identify the location(s) where you have received services from the Thames Valley Family Health Team.

* 2. Did you see:

* 3. Based on the many healthcare providers listed above, were you aware that you could access these providers through the Thames Valley Family Health Team?

* 4. The last time you were sick or concerned you had a health problem, how many days did it take from when you first tried to see your healthcare provider to when you actually saw him/her or someone else in the office?

* 5. Was it easy for you to schedule an appointment?

Based on your most recent visit, please check the response that best matches your opinion:

* 6. When you see your healthcare provider, do they involve you as much as you want to be in decisions about your care or treatment?

* 7. Did you find the facility welcoming, non-discriminating and comfortable (for example, the entrance, waiting room, decor, posters, or exam room)?

* 8. Were staff sensitive to your individual needs (for example, religion, language, accessibility needs, sexual orientation, ethnic background, gender, race, etc.)?

* 9. Did the services provided meet your individual needs (for example, religion, language, accessibility needs, sexual orientation, ethnic background, gender, race, etc.)?

* 10. Overall, how would you rate our services to you and your family?

* 11. Thinking of your overall experience with our clinic, what are...?

* 12. Is there any additional information or feedback you would like to share with us that could help us improve the way we provide care?

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