Patient Experience Survey

– Step 1 of 7

You are being invited to take part in this survey because you have recently had a visit at Huronia Nurse Practitioner-Led Clinic. Your responses to the questions on this survey will help us improve the care we provide.

There are six sections of the survey and it will take approximately 5 minutes to complete. Participation in the survey is completely voluntary and all your responses to the survey questions will be kept confidential.

Name *

First

Last

Are you completing this survey for yourself or for another person? *

I am completing this survey for myself
I am completing this survey for another person

Who are you completing this survey on behalf of? *

I am completing this for a family member or friend
I am completing this for the patient or client

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SECTION 1: CONTACTING US

How was the appointment for your most recent visit made? *

I didn’t have an appointment – I just dropped-in
I called and booked it
I emailed and booked it
I went online and booked it
I booked it at my last visit
You called me to book it

Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the following:

The length of time it took between making your appointment and the visit you just had *

Poor
Fair
Good
Very Good
Excellent

How long did it take to see a clinical staff member between making your appointment and the visit you had *

Same day
1 day
2-3 days
More than 3 days

Your overall experience accessing the office/clinic *

Poor
Fair
Good
Very Good
Excellent

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SECTION 2: ARRIVING AND WAITING AT THE OFFICE/CLINIC

Still thinking about your most recent visit, on a scale of poor to excellent, how would you rate the following …?

The length of time you had to wait in the reception/waiting area *

Poor
Fair
Good
Very Good
Excellent

Your overall experience with our reception staff *

Poor
Fair
Good
Very Good
Excellent

The length of time you had to wait in the examination room before you spoke with the health care provider about the reason for your visit *

Poor
Fair
Good
Very Good
Excellent

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SECTION 3: YOUR APPOINTMENT

Still thinking about your most recent visit, thinking about the MAIN health care provider you spoke with during the visit, on a scale of poor to excellent, how would you rate this person on the following …?

They knew about your medical history *

Poor
Fair
Good
Very Good
Excellent

They listened to your concerns *

Poor
Fair
Good
Very Good
Excellent

They spoke using a language you could understand *

Poor
Fair
Good
Very Good
Excellent

They explained things in a way that was easy to understand *

Poor
Fair
Good
Very Good
Excellent

They were sensitive to your needs and preferences *

Poor
Fair
Good
Very Good
Excellent

They treated you with dignity and respect *

Poor
Fair
Good
Very Good
Excellent

They gave you clear instructions about what you need to do after your visit *

Poor
Fair
Good
Very Good
Excellent

Your overall experience speaking with the health care provider about the reason for your visit *

Poor
Fair
Good
Very Good
Excellent

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SECTION 4: YOUR OVERALL EXPERIENCE WITH YOUR MOST RECENT VISIT

Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the following…?

The overall cleanliness of the office/ clinic *

Poor
Fair
Good
Very Good
Excellent

The overall physical comfort of the office/ clinic *

Poor
Fair
Good
Very Good
Excellent

Your confidence in the doctor/ health care provider(s) you saw during the visit *

Poor
Fair
Good
Very Good
Excellent

Your confidence that your health information was treated with the level of privacy you expect *

Poor
Fair
Good
Very Good
Excellent

Your overall experience with the visit you had with us *

Poor
Fair
Good
Very Good
Excellent

Did you feel comfortable and welcome? *

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SECTION 5: YOUR EXPERIENCES VISITING WITH US OVER THE LAST YEAR OR SO

The first couple of questions below are similar to ones asked earlier. However, instead of thinking about your most recent visit, we’d like you to think more broadly…about your experiences with us OVER THE LAST YEAR OR SO.

The last time you were sick or were concerned you had a health problem, did you get an appointment on the date you wanted? *

How long did you have to wait to see a clinical staff member in our clinic? *

Same day
Next day
2-3 days
3-5 days
More than 5 days
Not applicable (don’t know/refused)

How often do you see your own provider? (i.e., if you a patient of NP "A", how often do you get an appointment with them vs another provider? *

All of the time
Most of the time
Some of the time
None of the time

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 *

Never
Rarely
Sometimes
Often
Always

Involve you as much as you want to be in decisions about your care and treatment *

Never
Rarely
Sometimes
Often
Always

Spend enough time with you *

Never
Rarely
Sometimes
Often
Always

Over the last year or so did you receive care from a health care provider(s) at a location other than this practice? *

Thinking about the health care(s) providers that you have seen at the different places you have received care over the last year or so, how often…?

Did each seem to know your medical history *

Never
Rarely
Sometimes
Often
Always

Did each seem to have your recent tests or exam results *

Never
Rarely
Sometimes
Often
Always

Were they consistent in what they were telling you about your care and treatment? *

Never
Rarely
Sometimes
Often
Always

Did they seem to work well together in caring for you *

Never
Rarely
Sometimes
Often
Always

On another issue… The last time when you needed medical care in the evening, on a weekend, or on a public holiday, how easy was it to get care without going to the emergency department? *

Not Applicable
Very Easy
Somewhat Easy
Somewhat Difficult
Very Difficult

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SECTION 6: CONTEXT/DEMOGRAPHICS

In General… How would you rate your overall health? *

Poor
Fair
Good
Very good
Excellent

How long have you been visiting us for your health care? *

Less than six months
Between six months and a year
Between one and three years
Between three and five years
Longer than five years

Using your best guess, how many times did you visit us over the last year or so for your own medical care? *

One
Two
Three
Four
Five
Five or More

Would you recommend our services to your family or friends? *

Definitely No
Probably No
Probably Yes
Definitely Yes

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Your form entry has been saved and a unique link has been created which you can access to resume this form.

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Your Opinion Matters!

Patient Experience Survey

You are being invited to take part in this survey because you have recently had a visit at Huronia Nurse Practitioner-Led Clinic. Your responses to the questions on this survey will help us improve the care we provide.

There are six sections of the survey and it will take approximately 5 minutes to complete. Participation in the survey is completely voluntary and all your responses to the survey questions will be kept confidential.

SECTION 1: CONTACTING US

Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the following:

SECTION 2: ARRIVING AND WAITING AT THE OFFICE/CLINIC

Still thinking about your most recent visit, on a scale of poor to excellent, how would you rate the following …?

SECTION 3: YOUR APPOINTMENT

Still thinking about your most recent visit, thinking about the MAIN health care provider you spoke with during the visit, on a scale of poor to excellent, how would you rate this person on the following …?

SECTION 4: YOUR OVERALL EXPERIENCE WITH YOUR MOST RECENT VISIT

Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the following…?

SECTION 5: YOUR EXPERIENCES VISITING WITH US OVER THE LAST YEAR OR SO

The first couple of questions below are similar to ones asked earlier. However, instead of thinking about your most recent visit, we’d like you to think more broadly…about your experiences with us OVER THE LAST YEAR OR SO.

When you see your doctor or nurse practitioner, how often do they or someone else in the office…?

Thinking about the health care(s) providers that you have seen at the different places you have received care over the last year or so, how often…?

SECTION 6: CONTEXT/DEMOGRAPHICS

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