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	Comfort of our waiting room Poor	Comfort of our waiting room Fair	Comfort of our waiting room Good	Comfort of our waiting room Very Good	Comfort of our waiting room Excellent	Comfort of our waiting room N/A	Comfort of our waiting room Don't Know
Waiting time after you arrived at the clinic	Waiting time after you arrived at the clinic Poor	Waiting time after you arrived at the clinic Fair	Waiting time after you arrived at the clinic Good	Waiting time after you arrived at the clinic Very Good	Waiting time after you arrived at the clinic Excellent	Waiting time after you arrived at the clinic N/A	Waiting time after you arrived at the clinic Don't Know
Getting reminders for your visit	Getting reminders for your visit Poor	Getting reminders for your visit Fair	Getting reminders for your visit Good	Getting reminders for your visit Very Good	Getting reminders for your visit Excellent	Getting reminders for your visit N/A	Getting 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	Were welcoming upon your arrival Poor	Were welcoming upon your arrival Fair	Were welcoming upon your arrival Good	Were welcoming upon your arrival Very Good	Were welcoming upon your arrival Excellent	Were welcoming upon your arrival N/A	Were welcoming upon your arrival Don't Know
Were courteous and polite	Were courteous and polite Poor	Were courteous and polite Fair	Were courteous and polite Good	Were courteous and polite Very Good	Were courteous and polite Excellent	Were courteous and polite N/A	Were courteous and polite Don't Know
Let you know about any delays while you were waiting	Let you know about any delays while you were waiting Poor	Let you know about any delays while you were waiting Fair	Let you know about any delays while you were waiting Good	Let you know about any delays while you were waiting Very Good	Let you know about any delays while you were waiting Excellent	Let you know about any delays while you were waiting N/A	Let 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	Treated with respect Poor	Treated with respect Fair	Treated with respect Good	Treated with respect Very Good	Treated with respect Excellent	Treated with respect N/A	Treated with respect Don't Know
Cared about you as a person	Cared about you as a person Poor	Cared about you as a person Fair	Cared about you as a person Good	Cared about you as a person Very Good	Cared about you as a person Excellent	Cared about you as a person N/A	Cared about you as a person Don't Know
Showed sensitivity to your concerns	Showed sensitivity to your concerns Poor	Showed sensitivity to your concerns Fair	Showed sensitivity to your concerns Good	Showed sensitivity to your concerns Very Good	Showed sensitivity to your concerns Excellent	Showed sensitivity to your concerns N/A	Showed 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	The amount of useful information given about our condition Poor	The amount of useful information given about our condition Fair	The amount of useful information given about our condition Good	The amount of useful information given about our condition Very Good	The amount of useful information given about our condition Excellent	The amount of useful information given about our condition N/A	The amount of useful information given about our condition Don't Know
Information about how to stay healthy	Information about how to stay healthy Poor	Information about how to stay healthy Fair	Information about how to stay healthy Good	Information about how to stay healthy Very Good	Information about how to stay healthy Excellent	Information about how to stay healthy N/A	Information about how to stay healthy Don't Know
Information about how to prevent future health problems	Information about how to prevent future health problems Poor	Information about how to prevent future health problems Fair	Information about how to prevent future health problems Good	Information about how to prevent future health problems Very Good	Information about how to prevent future health problems Excellent	Information about how to prevent future health problems N/A	Information 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	Privacy in the waiting area Poor	Privacy in the waiting area Fair	Privacy in the waiting area Good	Privacy in the waiting area Very Good	Privacy in the waiting area Excellent	Privacy in the waiting area N/A	Privacy in the waiting area Don't know
Being able to discuss personal issues that were sensitive	Being able to discuss personal issues that were sensitive Poor	Being able to discuss personal issues that were sensitive Fair	Being able to discuss personal issues that were sensitive Good	Being able to discuss personal issues that were sensitive Very Good	Being able to discuss personal issues that were sensitive Excellent	Being able to discuss personal issues that were sensitive N/A	Being able to discuss personal issues that were sensitive Don't know
Asked your permission before another clinican came to the appointment	Asked your permission before another clinican came to the appointment Poor	Asked your permission before another clinican came to the appointment Fair	Asked your permission before another clinican came to the appointment Good	Asked your permission before another clinican came to the appointment Very Good	Asked your permission before another clinican came to the appointment Excellent	Asked your permission before another clinican came to the appointment N/A	Asked 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	Knew your medical history Poor	Knew your medical history Fair	Knew your medical history Good	Knew your medical history Very Good	Knew your medical history Excellent	Knew your medical history N/A	Knew your medical history Don't Know
Coordinated different healthcare professionals	Coordinated different healthcare professionals Poor	Coordinated different healthcare professionals Fair	Coordinated different healthcare professionals Good	Coordinated different healthcare professionals Very Good	Coordinated different healthcare professionals Excellent	Coordinated different healthcare professionals N/A	Coordinated different healthcare professionals Don't Know
Allowed you to have the final choice about which other professionals to see	Allowed you to have the final choice about which other professionals to see Poor	Allowed you to have the final choice about which other professionals to see Fair	Allowed you to have the final choice about which other professionals to see Good	Allowed you to have the final choice about which other professionals to see Very Good	Allowed you to have the final choice about which other professionals to see Excellent	Allowed you to have the final choice about which other professionals to see N/A	Allowed you to have the final choice about which other professionals to see Don't Know

Any additional comments?