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Patient Experience Survey

1. What is your age?
18 to 24  
25 to 34  
35 to 44  
45 to 54  
55 to 64  
65 to 74  
75 or Older  
2. What is Your Gender?
Female  Male  Other_Unspecified_prefer not to answer  
3. Are you aware of any of the following?
We are open after hours (Mon - Thurs until 8pm)
Yes No
We are open on Saturdays from 9AM to 12PM
Yes No
At any other time, you may call our Telehealth Nurse
Yes No
When you visit a walk-in clinic, we do not receive information regarding your visit.
Yes No
4. The last time you were sick, how many days did it take from when you first tried to see your doctor or nurse practitioner to when you actually saw him/her or someone else in their office?
Same day  Next day  2-3 days  4-7 days  8-19 days  20 days or more  Don't know  
5. Regarding Question #4, was this an acceptable time to wait?
Yes  No  Don't know  
6. Please check your reason(s) for going to a walk-in clinic in the last 6 months:
I have not used a walk-in clinic in the last 6 months
My doctor was not available on the day that I wanted
I could not travel to the Credit Valley Family Health Team on that occasion
The clinic was closed when I wanted to see my doctor
I feel that parking at the Credit Valley Family Health Team is too expensive
I was not aware that you had evening and Saturday clinics
I did not feel comfortable seeing a resident
Other
7. On a scale of 1-5, how confident are you that you can book an appointment with a physician or nurse practitioner in our office when you need to?
              
8. Thinking about your most recent visit, on a scale of poor to excellent, how would you rate your overall experience with our reception staff?
              
9. When you see your doctor or nurse practitioner, how often do they or someone else in the office give you an opportunity to ask questions about recommended treatment?
                 
10. When you see your doctor or nurse practitioner, how often do they or someone else in the office involve you as much as you want to be in decisions about your care and treatment?
                 
11. When you see your doctor or nurse practitioner, how often do they or someone else in the office spend enough time with you?
                 
12. Thinking about the MAIN health care provider you spoke with during the visit, how would you rate this person in terms of listening to your concerns?
              
13. Thinking about a physician you spoke with in a visit, on a scale of poor to excellent, how would you rate this person on the following....? Did your doctor let you say what was important?
              
14. Thinking about a physician you spoke with in a visit, on a scale of poor to excellent, how would you rate this person on the following....? Was your doctor concerned about your feelings?
              
15. Thinking about a physician you spoke with in a visit, on a scale of poor to excellent, how would you rate this person on the following....? Did your doctor take your health concerns seriously?
              
16. I have received a support from the following health care providers at Credit Valley Family Health Team, Please select all that apply
Nurse Practitioner
Pharmacist
Nurse
Social Worker
Dietitian
Diabetes Team
Chiropody
17. I participated in the following program(s). Please, select all that apply:
Smoking Cessation program
Asthma program
COPD program
18. Please select your Family Doctor or Nurse Practitioner:
19. On the scale of 1 to 10 below, would you recommend Credit Valley FHT to your friends and family
"1" Definitely No  "2"  "3"  "4"  "5"  "6"  "7"  "8"  "9"  "10" Definitely Yes  
Do you have any other comments about access to your physician?