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* 1. Who is completing this survey?

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* 2. Your experience was at which Huron Health System Facility?

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* 3. Your clinic visit was to which department?

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* 4. In the last 12 months, how many times (including this one) have you visited this outpatient clinic for any condition?

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* 5. Did the hospital change your appointment to a later date?

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* 6. Were you given directions to the location of the clinic inside the hospital?

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* 7. Before your appointment, did you know what would happen to you during the appointment?

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* 8. If your appointment did not start on time, how many minutes did you have to wait in the waiting room?

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* 9. If you had to wait, were you told why?

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* 10. Did a member of the staff tell you how you would find out the results of your test(s)?

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* 11. Before the treatment began, did a health professional explain any risks and/or benefits in a way you could understand?

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* 12. Did the health professionals treating and examining you introduce themselves?

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* 13. How much information about your condition or treatment was given to your family, caregiver or someone close to you?

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* 14. Were you given enough privacy when discussing your condition or treatment?

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* 15. Sometimes during an appointment, a health professional may say one thing and another may say something quite different. How often, during your most recent visit, did this happen to you?

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* 16. How often, during your most recent visit, were you involved as much as you wanted to be in decisions about your care and treatment?

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* 17. Before you left the outpatient area were you told what would happen next (for example, did you need another appointment, did you need to see you family doctor)?

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* 18. Did you receive enough information from hospital staff about what to do if you were worried about your condition or treatment after you left the hospital?

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* 19. Overall, did you feel you were treated with respect and dignity while you were at the clinic?

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* 20. Overall...(Please pick a number)

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* 21. Thinking about your experience related to this visit, to what extent did you experience smooth transitions between the outpatient area and other locations or health professionals?

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* 22. What else would you like to say about this outpatient experience? (Please do not include any names, contact information, or identifying information)

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* 23. Is there a staff member or group that you would like to recognize for providing exceptional care or service?

If you have any immediate questions or concerns regarding your experience with us, please contact our Patient Relations Office using the contact information below.

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