Welcome

You are being invited to take part in this survey because you have recently had a visit at our clinic. Your responses to the questions on this survey will help us improve the care we provide. It will take approximately 5 minutes to answer all questions. Participation in the survey is completely voluntary and all your responses to the survey questions will be kept confidential.

Question Title

* Q1-What is the location of your visit?

Question Title

* Q2-Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the following?

  Poor Fair Good Very Good Excellent
a.) The length of time it took between making your appointment and the visit you just had
b.) Your overall experience with our reception staff

Question Title

* Q3-Thinking about your experiences OVER THE LAST YEAR OR SO
Were there any barriers in accessing our services?

Question Title

* Q4-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 a doctor or nurse practitioner to when you actually SAW him / her or someone else in their office or our After Hours Clinic?

Question Title

* Q5-When you see your doctor or nurse practitioner, how often do they or someone else in the office...

  Never Rarely Sometimes Often Always
a.) Give you an opportunity to ask questions about recommended treatment
b.) Involve you as much as you want to be in decisions about your care and treatment
c.) Spend enough time with you

Question Title

* Q6-Have you been to an emergency department because you were sick or for a health related problem?

Question Title

* Q7-Which of the following was the MAIN reason you went to emergency rather than to your doctor or nurse practitioner? Select only one answer.

Question Title

* If you would like to provide additional feedback, please use the space below:

T