Patient Satisfaction Survey

Thank you for taking the time to complete this confidential questionnaire. Your opinion of our service is important to us and will help us to continually improve our healthcare service to all patients. For each statement below, please circle the number on the scale closest to your own experience. (5 = Strongly Agree, 1 = Strongly Disagree)

Date of Visit

Staff

ABOUT OUR CENTRE

1. I was happy with the care I received

2. The opening hours are convenient

3. The time I waited to see the doctor was acceptable

4. The way to make a complaint was easy to understand

5. I was able to access/read information on the Code of Rights

6. There was enough information available for my requirements

7. Staff were sensitive to my personal and cultural values

8. The parking area was adequate and well lit

9. I had no trouble accessing the building and facilities

10. I was aware that my medical notes could be forwarded to my GP

ABOUT THE STAFF YOU SAW TODAY

11. The doctor spent an appropriate length of time with me

12. The staff related well to me

13. The doctor was easy to understand and explained my condition well

14. I was given the opportunity to be involved in my care

15. I know how to get my test results

16. Information about my ongoing treatment was satisfactory

17. Follow-up care was explained

18. My consultation or treatment was conducted in an area that respected my privacy

19. Overall after your visit to our centre today, would you be happy returning in the future?

20. Were there any questions you did not understand? If yes, which ones?

21. Is there anything else you would like to tell us, to help us improve our service to you in the future

Finally, to help us better understand the needs of our community, we would like to know the following:

Are you

Male

Female

Prefer not to say

What age are you?

years old

What ethnicity are you?

Other Ethnicity(please specify)

If you are human, leave this field blank.