Sunset Country Family Health Team Patient Experience Survey
We ask that you please take a few minutes to fill out this survey to help us improve care. Your answers will be kept confidential and participation is voluntary.
* Required
I am completing this survey:
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For myself
For a family member
For a friend
Other
What is your primary care location:
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Sunset Country Family Health Team (SCFHT)
Kenora Medical Associates
Keewatin Medical Clinic
Docside Clinic
On your most recent visit:
What type of provider did you have an appointment with?
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Doctor
Nurse Practitioner
Other
What is the name of the provider that you saw on your most recent visit?
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Your answer
What type of visit did you have?
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In person (in the office)
Phone call
Video
Other
Do you think the wait time between the day you booked the appointment and the appointment date was reasonable?
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Excellent
Very good
Good
Fair
Poor
Not applicable
How was your experience when you were making an appointment?
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Excellent
Very good
Good
Fair
Poor
Not applicable
How was your experience with the reception staff?
*
Excellent
Very good
Good
Fair
Poor
Not applicable
Were there any barriers accessing services (e.g., hours of service, transportation, parking, accessibility)?
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Yes
No
Not applicable
If you answered YES to the above questions, please provide details.
Your answer
The last time you were sick, how many days did it take from when you first called to make an appointment with your doctor or nurse practitioner to when you actually had a visit with them or someone else in their office?
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Same day
Next day
2-19 days
20+ days
Not applicable
Over the last year:
When you see your doctor, nurse practitioner, or someone else in the office, how often do they spend enough time with you?
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Always
Often
Sometimes
Rarely
Never
Not applicable
When you see your doctor, nurse practitioner, or someone else in the office, how often do they give you an opportunity to ask questions about recommended treatment?
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Always
Often
Sometimes
Rarely
Never
Not applicable
When you see your doctor, nurse practitioner, or someone else in the office, how often do they involve you as much as you want to be in decisions about your care and treatment?
*
Always
Often
Sometimes
Rarely
Never
Not applicable
What could we do differently to involve you more in decisions about your care?
Your answer
If you received care virtually (i.e., video or phone call) in the last year, how was your overall experience?
*
Excellent
Very good
Good
Fair
Poor
Not applicable
If you received care virtually in the last year, how was your experience of care compared to an in-person visit?
Better
Same
Worse
Unsure
Clear selection
If you received care virtually, how likely is it that you would recommend it to friends or family?
Very likely
Likely
Neutral
Unlikely
Very unlikely
Clear selection
What would be your preferred appointment method with your provider in the future?
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In person (in the office)
Phone call
Video
Other
If you answered OTHER to the above question, please provide details.
Your answer
Do you feel empowered about your health care after an appointment with your provider?
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Yes
No
Not applicable
How many times did you go to the Emergency Department in the last year, instead of your doctor or nurse practitioner?
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0
1
2
3
4
5+
Did you receive health care at other agencies in the last year (e.g., WNHAC, Northwestern Health Unit, Canadian Mental Health Association, Physiotherapy)?
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Yes
No
Did you receive health care from a specialist in the last year?
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Yes
No
How often was information about your care shared efficiently between relevant providers?
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Always
Sometimes
Never
Not applicable
At anytime in the past year have you delayed or declined making an appointment with your health care provider because of COVID-19?
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Yes
No
How would you describe your overall health?
*
Excellent
Very good
Good
Fair
Poor
Please select your age
0 - 19 years
20 - 39 years
40 - 59 years
60 - 79 years
80 years or older
Clear selection
Is there anything we can do to make your experience better?
Your answer
How many times did you see your healthcare provider at either the Sunset Country Family Health Team, Keewatin Medical Clinic, Kenora Medical Associates, or Docside Clinics in the last year?
*
0 times
1-2 times
3-4 times
5+ times
Do you wish to be contacted regarding this survey?
*
Yes
No
If you answered YES to any of the above questions, please provide your name and contact information.
Your answer
Thank you for completing this survey!
This information will be used only to contact you if you have indicated above that you wish to be contacted regarding this survey. This information will not be shared with any healthcare providers and will not influence your quality of care.
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