Primary Care Patient Experience Survey

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* 2. Do you currently have a Family Doctor or Nurse Practitioner? *

Yes

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* 3. If Yes, Are they located in Fort Erie?

Yes

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* 4. How often do you see your family doctor? *

Every 6 months

Once a year

As often as needed

Don't have a doctor

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* 5. On average, how long do you have to wait for an appointment with your family doctor for urgent matters? *

I usually receive an appointment when I require it

I usually have to wait 2-5 days

I usually have to wait 5-10 days

I have to wait longer than 10 days

Other (please specify)

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* 6. How do you rate this wait time? *

Very acceptable

Acceptable

Moderately acceptable

Not very acceptable

Not acceptable at all

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* 7. How easy was it to get through to someone at your clinic on the phone? *

Very easy

Fairly easy

Not very easy

Not easy at all

Other (please specify)

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* 8. Do you access the services of a walk-in clinic? *

Yes

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* 9. How often do you need to go to a walk-in clinic? *

At least once a month

Once every couple months

a couple times a year

Rarely

Never

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* 10. Are you able to get health advice from your clinic over the phone? *

Yes

Other (please specify)

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* 11. In the last 12 months has your family doctor's office provided everything you need to help you manage your health concerns? *

Yes, definitely

Yes, to some extent

No, not really

No, not at all

No, I haven't needed such support

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* 12. In the last 12 months, have you had enough support from local services or organizations to help you manage your health concerns? *

Yes, definitely

Yes, to some extent

No, not really

No, not at all

No, I haven't needed such support

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* 13. Do you regularly get your preventative cancer screening tests completed? *

Yes

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* 14. Does your family doctor or nurse practitioner offer after-hours services to their patients? (over the phone or in person) *

Yes

Don't know

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* 15. Where do you go if you need to access walk-in clinic services? *

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* 16. Do you go to your local Pharmacist for minor ailments that they can diagnose and prescribe for?

Yes

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* 17. Of these services in Fort Erie please check the ones you are aware of. *

Pathstone Mental Health

Screen for Life - Mobile Cancer Screening Coach

Diabetes Education Program

Niagara Sexual Assault Centre

Community Addictions Centre

REACH Niagara Mobile Health Services

Ontario Seniors Dental Care Program

None of the Above

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* 18. What other Specialty Clinics should be offered in the Fort Erie community? Please check those you think are important. *

Social Work

Physiotherapy

Psychiatry

Paediatrics

Cardiology

Respirology

Life Coaching Program

Cardiac Rehab

Urology

Gynecology

Obstetrics

Surgical

Dermatology

Oncology

Other (please specify)

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* 19. Do you have a dentist? *

Yes

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* 20. Do you seek dental services annually? *

Yes

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* 21. Do you have insurance coverage for dental services? *

Yes

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* 22. Please indicate the area where you currently reside *

Fort Erie

Ridgeway

Crystal Beach

Stevensville

Other (please specify)

Primary Care Patient Experience Survey

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* 1. Please enter your postal code*

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* 2. Do you currently have a Family Doctor or Nurse Practitioner? *

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* 3. If Yes, Are they located in Fort Erie?

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* 4. How often do you see your family doctor? *

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* 5. On average, how long do you have to wait for an appointment with your family doctor for urgent matters? *

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* 6. How do you rate this wait time? *

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* 7. How easy was it to get through to someone at your clinic on the phone? *

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* 8. Do you access the services of a walk-in clinic? *

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* 9. How often do you need to go to a walk-in clinic? *

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* 10. Are you able to get health advice from your clinic over the phone? *

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* 11. In the last 12 months has your family doctor's office provided everything you need to help you manage your health concerns? *

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* 12. In the last 12 months, have you had enough support from local services or organizations to help you manage your health concerns? *

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* 13. Do you regularly get your preventative cancer screening tests completed? *

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* 14. Does your family doctor or nurse practitioner offer after-hours services to their patients? (over the phone or in person) *

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* 15. Where do you go if you need to access walk-in clinic services? *

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* 16. Do you go to your local Pharmacist for minor ailments that they can diagnose and prescribe for?

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* 17. Of these services in Fort Erie please check the ones you are aware of. *

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* 18. What other Specialty Clinics should be offered in the Fort Erie community? Please check those you think are important. *

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* 19. Do you have a dentist? *

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* 20. Do you seek dental services annually? *

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* 21. Do you have insurance coverage for dental services? *

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* 22. Please indicate the area where you currently reside *

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* 23. If you have additional comments, please write them down in the space provided. We will review them with great interest.