Montfort Academic Family Health Team

In an effort to improve our services we would appreciate you taking 10 minutes to complete our confidential patient survey. Thank you in advance!


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Thinking about the doctor or nurse practitioner you have seen the most over the past 12 months, were there times when you (Check all that apply):

 

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 the office for an urgent medical condition?

The last time you were sick or were concerned you had a health problem did you get an appointment on the day you wanted?

In the past 12 months have you gone to the Emergency Department or a different clinic because you could not see your doctor, nurse practitioner or someone else in the office in the time period you wanted?

How satisfied are you with the respect and courtesy shown by the clerks, receptionists and medical secretaries at your clinic?

How satisfied are you with being able to communicate to your healthcare provider in your language of choice?

How satisfied are you with having your healthcare issues resolved by phone, email or other electronic means (eg portal) without having to visit your clinic?

How satisfied are you with the types of wellness programs and services offered by healthcare providers (eg nurse, dietitian, social worker) at your clinic?

How satisfied are you with the length of time between making an appointment and seeing a nurse, dietician or others?

How satisfied are you with the length of time between making an appointment and seeing a social worker or psychologist at your clinic?

How satisfied are you with the hours of service offered by your clinic on weekends?

How satisfied are you with the hours of service offered by your clinic evenings after 5 PM?

How satisfied are you with the hours of service offered by your clinic early morning before 8:30 or 9:00 AM?

When you visit your doctor or nurse practitioner how often do they or someone else in the clinic give you the opportunity to ask questions about the recommended treatment?

When you visit your doctor or nurse practitioner how often do they or someone else in the clinic involve you as much as you want in the decisions about your care and treatment?


When you visit your doctor or nurse practitioner do you feel comfortable talking with them about personal problems related to your health condition?

When you visit your doctor, how often does he/she let you say what is important to you?

When you visit your doctor, how often does he/she take your health concerns seriously?

When you visit your doctor, how often does he/she show concern for your feelings?

Please indicate if you received healthcare outside of your clinic in the past 12 months (Check all that apply):
 

Would you recommend the services of your clinic to friends or family?


ABOUT YOU:
Gender

Age

Language
 

How many years have you been a patient at this clinic?

In the last 12 months, how many times did you visit this clinic?


In general how would you rate your overall health?


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