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Patients
How to become a patient
Book an Appointment Online
Rights and Responsibilities
Healthcard
Useful Links
Patient Experience Survey
New Patient Form
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?
1(Least Confident)
2
3
4
5(Most Confident)
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?
Excellent
Very Good
Good
Fair
Poor
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?
Always
Usually/Often
Sometimes
Rarely
Never
Don't know
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?
Always
Usually/Often
Sometimes
Rarely
Never
Don't know
11.
When you see your doctor or nurse practitioner, how often do they or someone else in the office spend enough time with you?
Always
Usually/Often
Sometimes
Rarely
Never
Don't know
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?
Excellent
Very Good
Good
Fair
Poor
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?
Excellent
Very Good
Good
Fair
Poor
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?
Excellent
Very Good
Good
Fair
Poor
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?
Excellent
Very Good
Good
Fair
Poor
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:
Select...
Dr. Gihane Zarifa
Dr. Christine Pereira
Dr. Michael Kroll
Dr. James Pencharz
Dr. Melissa Graham
Dr. Nina Yashpal
Dr. Kimberley Kent
Dr. Robert Cho
Dr. Paul Cheung
Dr. Ali Damji
Dr. Sandra Toutounji
Dr. Sahra Gedleh
Natalia Makeeva
Sukhmani Bedi
Joshua Christopher
Dr. Karina Prucnal
Dr. Deema Couchman
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?