BVIHSA Patient Satisfactory Survey
Community Clinics

We are here to serve and partner with you!

Please help us to improve our services by completing this questionnaire.

Your responses will be held confidential by our team.

Thank you for helping us improve!

Question Title

* 1. What gender do you identify?

Male

Female

Prefer not to say

Question Title

* 2. Age Group (in years)

0-14 years

15-19 years

20-24 years

25-29 years

30-34 years

35-39 years

40-44 years

45-49 years

50-54 years

55-59 years

60-64 years

65+ years

Question Title

* 3. Which clinic did you access today?
(Choose one. If you would like to give feedback on another clinic please fill out another survey.)

East End (Iris Penn)

Long Look (Rosalind Penn)

Capoons Bay (Theresa Blyden)

Road Town

Nurse Iris O'Neal

North Sound

Jost Van Dyke

Anegada (Nurse Romalia Smith)

Other (please specify)

Question Title

* 4. Which services have you accessed today? (Tick all that apply)

Antenatal Care

Postnatal Care

Child Health

Vaccines

Family Planning

Sexual Health

Nutrition Clinic

Mental Health

Audiology

Weight Check

Chronic Disease

Dental Clinic

Endocrine Clinic

Doctor's Clinic

Postnatal (Home Visit)

Wound Care (Home Visit)

Wound Care (Clinic)

Routine Home Visits (Elderly/Vulnerable)

Immunization (Home Visit)

Medication Administration (Home Visit)

Doctor Visit

Telemedicine by Dr.

Telemedicine by Nurse

Routine Checks by Nurse

Blood Pressure/Sugar Check

Other (please specify)

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BVIHSA Patient Satisfactory Survey Community Clinics

Question Title

* 1. What gender do you identify?

Question Title

* 2. Age Group (in years)

Question Title

* 3. Which clinic did you access today? (Choose one. If you would like to give feedback on another clinic please fill out another survey.)

Question Title

* 4. Which services have you accessed today? (Tick all that apply)

BVIHSA Patient Satisfactory Survey
Community Clinics

* 3. Which clinic did you access today?
(Choose one. If you would like to give feedback on another clinic please fill out another survey.)