Patient of Clinic Experience Survey

Patient Experience Survey for Clinic Services

Please take a few moments to provide insights about your experience with our Clinic services. Shared information helps us to help others. We value your opinion and hope together we can collaborate with the common goal of optimizing our healthcare services for you or your loved one. Sharing your experiences also highlights area that could be improved upon, whether it be scheduling, resource allocation or enhanced personal care. Please note, the information received is reviewed regularly as part of our quality assurance program. Thank you for sharing with us today.

Clerical Services at the Clinic

Were the staff friendly and professional who helped you today?

Were the given instructions for your examination clear?

Were your questions answered/concerns addressed?

While visiting the Clinic

Were you pleased with the level of cleanliness at the clinic?

Was the atmosphere pleasant and professional?

Did you have any difficulty accessing the clinic or its services?

Did a support person or animal come with you today?

Were your belongings secure and did you feel safe during your visit?

Was your privacy supported (i.e., type of gown, change room area)?

During your exam

Did the technical staff make you feel comfortable?

Was the technologist knowledgeable and professional?

Were you treated in a dignified and respectful manner?

Overall Services

Was it easy to book your appointment?

Did you book your appointment online?

Were urgent appointments available?

Was there a long wait time to be seen, past the time of your appointment?

Affected Your Decision to Visit Us Today

Recommendation of Clinic or Google Reviews

Availability of Appointments

Weekend Appointment Availability

A Few Questions About You

Are you a patient of the clinic, a family member or Power of Attorney?

Are you (or your loved one) here today for an urgent or routine exam?

Which service are you here to partake of?

How old are you?

How would you describe your current overall health?

Comments or Other Suggestions

Overall, how would you rate our clinic compared to others or the local hospital?

How likely are you to use our clinic services again?

Would you recommend our clinic to family or friends?

Is there anything we can do to improve our clinic services?

If you would like to discuss with our management team, please check:

Yes No

Contact Information

If you answered yes to having our management team reach out to discuss your form with you, please provide us with your contact information below

Name:

Best Daytime Phone Number:

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Date:

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Survey - Clinic

Patient Experience Survey for Clinic Services