Patient Experience Questionnaire 2022

Thank you for providing feedback on our services at CCFP.

This form will only take between 5-10mins to complete.

We are seeking this feedback as a part of our accreditation activities, and so we can improve our service delivery.

HINT: This form is best with your phone in landscape mode!

Age

Gender

Ethnicity

Languages spoken at home

Do you have a Health Care Card?

Times you have visited the clinic in the last year

Making an appointment and waiting to see a clinician at your last visit

	Poor	Fair	Good	Very Good	Excellent	N/A	Don't Know
Comfort of our waiting room	PoorComfort of our waiting room Poor	FairComfort of our waiting room Fair	GoodComfort of our waiting room Good	Very GoodComfort of our waiting room Very Good	ExcellentComfort of our waiting room Excellent	N/AComfort of our waiting room N/A	Don't KnowComfort of our waiting room Don't Know
Waiting time after you arrived at the clinic	PoorWaiting time after you arrived at the clinic Poor	FairWaiting time after you arrived at the clinic Fair	GoodWaiting time after you arrived at the clinic Good	Very GoodWaiting time after you arrived at the clinic Very Good	ExcellentWaiting time after you arrived at the clinic Excellent	N/AWaiting time after you arrived at the clinic N/A	Don't KnowWaiting time after you arrived at the clinic Don't Know
Getting reminders for your visit	PoorGetting reminders for your visit Poor	FairGetting reminders for your visit Fair	GoodGetting reminders for your visit Good	Very GoodGetting reminders for your visit Very Good	ExcellentGetting reminders for your visit Excellent	N/AGetting reminders for your visit N/A	Don't KnowGetting reminders for your visit Don't Know

Your experience with reception staff at your last visit

	Poor	Fair	Good	Very Good	Excellent	N/A	Don't Know
Were welcoming upon your arrival	PoorWere welcoming upon your arrival Poor	FairWere welcoming upon your arrival Fair	GoodWere welcoming upon your arrival Good	Very GoodWere welcoming upon your arrival Very Good	ExcellentWere welcoming upon your arrival Excellent	N/AWere welcoming upon your arrival N/A	Don't KnowWere welcoming upon your arrival Don't Know
Were courteous and polite	PoorWere courteous and polite Poor	FairWere courteous and polite Fair	GoodWere courteous and polite Good	Very GoodWere courteous and polite Very Good	ExcellentWere courteous and polite Excellent	N/AWere courteous and polite N/A	Don't KnowWere courteous and polite Don't Know
Let you know about any delays while you were waiting	PoorLet you know about any delays while you were waiting Poor	FairLet you know about any delays while you were waiting Fair	GoodLet you know about any delays while you were waiting Good	Very GoodLet you know about any delays while you were waiting Very Good	ExcellentLet you know about any delays while you were waiting Excellent	N/ALet you know about any delays while you were waiting N/A	Don't KnowLet you know about any delays while you were waiting Don't Know

Your experience of the interpersonal skill of the clinician at your last visit

	Poor	Fair	Good	Very Good	Excellent	N/A	Don't Know
Treated with respect	PoorTreated with respect Poor	FairTreated with respect Fair	GoodTreated with respect Good	Very GoodTreated with respect Very Good	ExcellentTreated with respect Excellent	N/ATreated with respect N/A	Don't KnowTreated with respect Don't Know
Cared about you as a person	PoorCared about you as a person Poor	FairCared about you as a person Fair	GoodCared about you as a person Good	Very GoodCared about you as a person Very Good	ExcellentCared about you as a person Excellent	N/ACared about you as a person N/A	Don't KnowCared about you as a person Don't Know
Showed sensitivity to your concerns	PoorShowed sensitivity to your concerns Poor	FairShowed sensitivity to your concerns Fair	GoodShowed sensitivity to your concerns Good	Very GoodShowed sensitivity to your concerns Very Good	ExcellentShowed sensitivity to your concerns Excellent	N/AShowed sensitivity to your concerns N/A	Don't KnowShowed sensitivity to your concerns Don't Know

Your experience of the information given to you by clinicians at your last visit

	Poor	Fair	Good	Very Good	Excellent	N/A	Don't Know
The amount of useful information given about our condition	PoorThe amount of useful information given about our condition Poor	FairThe amount of useful information given about our condition Fair	GoodThe amount of useful information given about our condition Good	Very GoodThe amount of useful information given about our condition Very Good	ExcellentThe amount of useful information given about our condition Excellent	N/AThe amount of useful information given about our condition N/A	Don't KnowThe amount of useful information given about our condition Don't Know
Information about how to stay healthy	PoorInformation about how to stay healthy Poor	FairInformation about how to stay healthy Fair	GoodInformation about how to stay healthy Good	Very GoodInformation about how to stay healthy Very Good	ExcellentInformation about how to stay healthy Excellent	N/AInformation about how to stay healthy N/A	Don't KnowInformation about how to stay healthy Don't Know
Information about how to prevent future health problems	PoorInformation about how to prevent future health problems Poor	FairInformation about how to prevent future health problems Fair	GoodInformation about how to prevent future health problems Good	Very GoodInformation about how to prevent future health problems Very Good	ExcellentInformation about how to prevent future health problems Excellent	N/AInformation about how to prevent future health problems N/A	Don't KnowInformation about how to prevent future health problems Don't Know

Your experience of privacy at your last visit

	Poor	Fair	Good	Very Good	Excellent	N/A	Don't know
Privacy in the waiting area	PoorPrivacy in the waiting area Poor	FairPrivacy in the waiting area Fair	GoodPrivacy in the waiting area Good	Very GoodPrivacy in the waiting area Very Good	ExcellentPrivacy in the waiting area Excellent	N/APrivacy in the waiting area N/A	Don't knowPrivacy in the waiting area Don't know
Being able to discuss personal issues that were sensitive	PoorBeing able to discuss personal issues that were sensitive Poor	FairBeing able to discuss personal issues that were sensitive Fair	GoodBeing able to discuss personal issues that were sensitive Good	Very GoodBeing able to discuss personal issues that were sensitive Very Good	ExcellentBeing able to discuss personal issues that were sensitive Excellent	N/ABeing able to discuss personal issues that were sensitive N/A	Don't knowBeing able to discuss personal issues that were sensitive Don't know
Asked your permission before another clinican came to the appointment	PoorAsked your permission before another clinican came to the appointment Poor	FairAsked your permission before another clinican came to the appointment Fair	GoodAsked your permission before another clinican came to the appointment Good	Very GoodAsked your permission before another clinican came to the appointment Very Good	ExcellentAsked your permission before another clinican came to the appointment Excellent	N/AAsked your permission before another clinican came to the appointment N/A	Don't knowAsked your permission before another clinican came to the appointment Don't know

Your experience of the way your clinician worked with other healthcare professinal at your last visit

	Poor	Fair	Good	Very Good	Excellent	N/A	Don't Know
Knew your medical history	PoorKnew your medical history Poor	FairKnew your medical history Fair	GoodKnew your medical history Good	Very GoodKnew your medical history Very Good	ExcellentKnew your medical history Excellent	N/AKnew your medical history N/A	Don't KnowKnew your medical history Don't Know
Coordinated different healthcare professionals	PoorCoordinated different healthcare professionals Poor	FairCoordinated different healthcare professionals Fair	GoodCoordinated different healthcare professionals Good	Very GoodCoordinated different healthcare professionals Very Good	ExcellentCoordinated different healthcare professionals Excellent	N/ACoordinated different healthcare professionals N/A	Don't KnowCoordinated different healthcare professionals Don't Know
Allowed you to have the final choice about which other professionals to see	PoorAllowed you to have the final choice about which other professionals to see Poor	FairAllowed you to have the final choice about which other professionals to see Fair	GoodAllowed you to have the final choice about which other professionals to see Good	Very GoodAllowed you to have the final choice about which other professionals to see Very Good	ExcellentAllowed you to have the final choice about which other professionals to see Excellent	N/AAllowed you to have the final choice about which other professionals to see N/A	Don't KnowAllowed you to have the final choice about which other professionals to see Don't Know

Any additional comments?