Patient Survey – Capreol NPLC

CAPREOL NURSE PRACTITIONER-LED CLINIC

PATIENT EXPERIENCE SURVEY

Your responses to the questions on this survey will help us improve the care we provide. Participation in the survey is completely voluntary and all your responses to the survey will be kept confidential.

1. The last time you were sick or were concerned you had a health problem, how many days did it take from when you first tried to see your Nurse Practitioner to when you actually saw them or someone else at our clinic? *

Enter the number of days

2. Did you get an appointment on the day you wanted or within an acceptable timeframe? *

3. b) If you have received care at a walk-in clinic or Emergency Department, what was the reason for the visit?

Appointment was not available at our clinic
It was evening / week-end / holiday
Other

If you chose "Other", please specify the reason for the visit

4. a) Have you been admitted to the hospital in the past 12 months? *

4. b) If yes, did you book or did someone call you from our clinic to book a follow-up appointment?

(Note: We strongly recommend booking a post-hospital discharge follow-up within 7 days)

5. a) Do you take prescription medication(s) on an ongoing basis? *

5. b) If yes, in the past 12 months, did you review your medications with your Nurse Practitioner and/or Pharmacist?

Yes
No
Don't know / Unsure

6. When you see your health care provider(s), how often do they or someone else in our clinic…? *

	Always	Often	Sometimes	Rarely	Never
a. Give you an opportunity to ask questions about recommended treatment	a. Give you an opportunity to ask questions about recommended treatment Always	a. Give you an opportunity to ask questions about recommended treatment Often	a. Give you an opportunity to ask questions about recommended treatment Sometimes	a. Give you an opportunity to ask questions about recommended treatment Rarely	a. Give you an opportunity to ask questions about recommended treatment Never
b. Involve you as much as you want to be in decisions about your care/treatment	b. Involve you as much as you want to be in decisions about your care/treatment Always	b. Involve you as much as you want to be in decisions about your care/treatment Often	b. Involve you as much as you want to be in decisions about your care/treatment Sometimes	b. Involve you as much as you want to be in decisions about your care/treatment Rarely	b. Involve you as much as you want to be in decisions about your care/treatment Never
c. Spend enough time with you	c. Spend enough time with you Always	c. Spend enough time with you Often	c. Spend enough time with you Sometimes	c. Spend enough time with you Rarely	c. Spend enough time with you Never

If Other, please specify

8. Did staff make you feel welcome at our clinic? *

10. Would you recommend our services to friends or your family? *

Definitely yes
Probably yes
Probably no
Definitely no

11. Please list any areas in which our service could be improved or any other comments/suggestions about our clinic.

May we add your comments to our website? (Your responses will remain anonymous) *

Name

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
(Phones are answered 8:30am – 4:00pm)
Closed for lunch 12:00pm – 1:00pm

Tues – 8:00am – 7:30pm (Phones are answered 8:30am – 7:30pm)
Closed 12:00pm – 1:00pm for lunch and 4:00pm – 5:00pm

LifeLabs services
LifeLabs services will be available to the community on Tuesdays 8:00am-12:00pm. No appointment required. Please bring your health card and requisition.

CAPREOL NURSE PRACTITIONER-LED CLINIC

PATIENT EXPERIENCE SURVEY

Capreol Nurse Practitioner-Led Clinic