Patient Experience Survey
1.
The last time you were sick or were concerned you had a health problem, how many days did it take from when you first tried to see your Nurse Practitioner to when you actually saw them or someone else at the clinic?
same day
next day
2-19 days
20 or more days
Not applicable/I don't know
Other (please specify)
2.
Did you get an appointment on the day you wanted or within an acceptable time?
Yes
No
3.
How many times in the last 12 months have you received care at a walk-in clinic or emergency room?
None
1-3
4-6
7-9
10+
4.
If you received care at a walk-in clinic or emergency room, what was the reason?
Appointment at this clinic not available
It was an evening, weekend, holiday
Other
Other (please specify)
5.
Have you been admitted to hospital in the last 12 months?
Yes
No
6.
If yes, did you have follow up from the clinic about your admission to hospital?
Yes
No
7.
Do you take prescription medications on an ongoing basis?
Yes
No
8.
If yes, have you reviewed the mdications you take in the last 12 months with your NP or the Pharmacist?
Yes
No
Other/Don't know
9.
When you see your health care provider, how often do they or someone else at the clinic give you an opportunity to ask questions about your recommended treatment?
Always
Usually
Sometimes
Rarely
Never
10.
How often does your provider (this clinic) involve you in the decisions about your care/treatment?
Always
Usually
Sometimes
Rarely
Never
11.
Does your provider or the person you see at the clinic spend enough time with you during your appointments?
Always
Usually
Sometimes
Rarely
Never
12.
We are a team-based care model. Please tell us whom you saw in the past 12 months at our clinic. Please check all that apply.
Nurse Practitioner
Social Worker
Nurse
Respiratory Therapist
Pharmacist
Physician
Dietitian
13.
Do the staff make you feel welcomed here?
Yes
No
14.
How would you rate your overall experience with the clinic?
Excellent
Very Good
Good
Fair
Poor
Other (please specify)
15.
Would you recommend our services to friends or your family? Check one only
Definitely Yes
Probably Yes
Probably No
Definitely No
16.
Please list any areas you feel we could improve or offer any suggestions you may have.
17.
Can we share your comments on our website and social media?
Yes
No
Current Progress,
0 of 17 answered