Patient Advisory Council Feedback Survey

Patient Advisory Council
Feedback Survey

The Patient Advisory Council’s role is to provide clinic staff with feedback regarding community needs for programs and services, and to strengthen communications between the clinic and the community.

To assist us in meeting our goals, we encourage you to complete the following survey. It is completely anonymous unless you choose to put your name and contact information on it.

Your survey will be forwarded to the Council where we will study the information provided and make recommendations to the CNPLC Executive Director for consideration.

Thank You for your participation!

Are you satisfied with the wait time for appointments?

Do you understand the reasoning behind prescriptions you are given?

In general, do you feel you are healthy?

If not, what do you think prevents you from being healthier?

Do you have a condition that CNPLC currently cannot treat on-site?

If so, what treatment do you receive elsewhere?

Have you had an unpleasant interaction with any of the staff at the Clinic?

If yes, did you put a note in the suggestion box so that the problem could be addressed?

If yes, did you see a change in the situation on your next visit?

If CNPLC provided health promotion events, what topics do you think would benefit you?

Do you feel certain staff ‘go the extra mile’ to help you with your health concerns?

If yes, do you think they should be recognized?

Do you have any other suggestions for staff or administration?

The following is a list of services and programs provided at CNPLC, all of which are either free of charge or covered by OHIP (two exceptions are indicated with $ after the service). You can help us by indicating with a check mark which services/programs you were aware of, and which services/programs you have used at CNPLC.

Services and Programs

	Aware	Used
Outreach clinic for persons living with diabetes	Outreach clinic for persons living with diabetes Aware	Outreach clinic for persons living with diabetes Used
Immunizations clinic (vaccination against common infectious diseases)	Immunizations clinic (vaccination against common infectious diseases) Aware	Immunizations clinic (vaccination against common infectious diseases) Used
Fall flu immunization clinic	Fall flu immunization clinic Aware	Fall flu immunization clinic Used
Smoking cessation	Smoking cessation Aware	Smoking cessation Used
Counselling with social worker	Counselling with social worker Aware	Counselling with social worker Used
Dietitian appointments	Dietitian appointments Aware	Dietitian appointments Used
Well baby/Prenatal care	Well baby/Prenatal care Aware	Well baby/Prenatal care Used
Monitoring and management of chronic diseases such as	Monitoring and management of chronic diseases such as Aware	Monitoring and management of chronic diseases such as Used
diabetes	diabetes Aware	diabetes Used
high blood pressure	high blood pressure Aware	high blood pressure Used
arthritis	arthritis Aware	arthritis Used
asthma	asthma Aware	asthma Used
heart disease	heart disease Aware	heart disease Used
Stand Up Fitness Program	Stand Up Fitness Program Aware	Stand Up Fitness Program Used
Moving for Mood Program	Moving for Mood Program Aware	Moving for Mood Program Used
Chronic pain workshop	Chronic pain workshop Aware	Chronic pain workshop Used
Diabetes Management workshop	Diabetes Management workshop Aware	Diabetes Management workshop Used
Nutrition info sessions (Dietitian Services)	Nutrition info sessions (Dietitian Services) Aware	Nutrition info sessions (Dietitian Services) Used
Advance Foot Care	Advance Foot Care Aware	Advance Foot Care Used
Reflexology	Reflexology Aware	Reflexology Used
Soup to Tomatoes Fitness Program	Soup to Tomatoes Fitness Program Aware	Soup to Tomatoes Fitness Program Used
Home visits	Home visits Aware	Home visits Used
Same day appointments for illnesses	Same day appointments for illnesses Aware	Same day appointments for illnesses Used
Dressing changes	Dressing changes Aware	Dressing changes Used
IUD insertions	IUD insertions Aware	IUD insertions Used
Cortisone injections	Cortisone injections Aware	Cortisone injections Used
Minor procedures (toe nail removal, lesion removal)	Minor procedures (toe nail removal, lesion removal) Aware	Minor procedures (toe nail removal, lesion removal) Used
Cosmetic lesion removal $	Cosmetic lesion removal $ Aware	Cosmetic lesion removal $ Used
Wart treatments $	Wart treatments $ Aware	Wart treatments $ Used

Comment

49 Young Street
Capreol, ON P0M 1H0
Tel: 705-858-8787 Fax: 705-589-3018

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Hours
Mon., Wed., Thurs., Fri. – 8:00am – 4:00pm
Tuesday – 8:00am – 7:30pm
Sat., Sun. – Closed

Life Lab services
Thursdays 8:30am-12:00pm by appointment for registered patients.

Patient Advisory Council Feedback Survey

Capreol Nurse Practitioner-Led Clinic

Patient Advisory Council
Feedback Survey