PATIENT EXPERIENCE SURVEY

You are being invited to take part in this survey because you have recently had a visit at the Essex County Nurse Practitioner-Led Clinic.

Your responses to the questions on this survey will help us improve the care we provide. There are six sections of the survey and it will take approximately 5 minutes to complete.

Participation in the survey is completely voluntary and all your responses to the survey questions will be kept confidential.

    Section 1

    Please select your clinic location: Are you completing this survey for yourself or someone else? If you are completing this survey for someone else, who are you completing it for?
    Please specify:

    Section 2: Contacting Us

    Q1. How was the appointment for your most recent visit made?
    Q1a. On a scale of poor to excellent, how would you rate the length of time it took between making your appointment and your most recent visit?

     

    Q2. On a scale of poor to excellent, how would you rate your overall experience accessing the office/clinic?

    Section 3: Arriving and waiting at the office/clinic

    Q3. On a scale of poor to excellent, how would you rate the following? a. The length of time you had to wait in the reception/waiting area b. Your overall experience with our reception staff c. The length of time you had to wait in the examination room

    Section 4: Your Appointment

    Q4. Thinking about the MAIN health care provider you spoke with during the visit, on a scale of poor to excellent, how would you rate this person on the following ... a. They knew about your medical history b. They listened to your concerns c. They spoke using a language you could understand d. They explained things in a way that was easy to understand e. They were sensitive to your needs and preferences f. They treated you with dignity and respect g. They gave you clear instructions about what you need to do after your visit h. Your overall experience speaking with the health care provider about the reason for your visit

    Section 5: Your Overall Experience With Your Most Recent Visit

    Q5. Thinking about your most recent visit, how would you rate the following ... a. The overall cleanliness of the office/clinic b. The overall physical comfort of the office/clinic c. Your confidence in the doctor/health care provider(s) you saw during your visit d. Your confidence that your health information was treated with the level of privacy you expect e. Your overall experience with the visit you had with us

    Section 6: Your Experiences Visiting With Us Over the Last Year or So

    The first couple of questions below are similar to ones asked earlier. However, instead of thinking about your most recent visit, We'd like you to think more broadly ... about your experiences with us OVER THE LAST YEAR OR SO. Q6. The last time your were sick or were concerned you had a health problem ... a. Did you get an appointment on the date you wanted? b. How many days did it take from when you first tried to see your doctor or nurse practitioner to when you actually SAW him/her or someone else in their office? Q7. When you see your doctor or nurse practitioner, how often do they or someone else in the office ... a. Give you the 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 Q8. Over the last year or so ... Did you receive care from your healthcare provider(s) at a location other than this practice?
    Q8a. Thinking about the healthcare provider(s) that you have seen at the different places you have received health care over the last year or so, how often ... a. Did each seem to know your medical history? b. Did each seem to have your recent test or exam results? c. Were they consistent in what they were telling you about your care and treatment? d. Did they seem to work well together in caring for you?

     

    Q9. On another issue, the last time you needed medical care in the evening, on a weekend, or on a public holiday, how easy was it to get care without going to the emergency department?

    Section 7: Context/Demographics

    Q10. In general, how would you rate your overall health? Q11. How long have you been visiting us for your health care? Q12. Using your best guess, how many times did you visit us over the last year or so for your own medical care? Q13. Would you recommend our services to your family or friends?

    Feedback (optional)

    (If you do not wish to provide additional feedback, please click submit at the bottom) Thinking of your overall experience with our office/clinic, what are ... a. Two things that were done particularly well. b. Two things that could be improved.