Patient Feedback Survey
We would love to hear feedback on your most recent experience at Monbulk Family Clinic.
* Please note that your personal details such as name, email address and contact number will not be collected or made available to us.
Sign in to Google to save your progress. Learn more
Q1: Making an appointment and waiting to see a clinician at your last visit.
Please rate each statement
a. Seeing a clinician of your choice
Clear selection
b. Getting an appointment for a time that suited
Clear selection
c. The time you had to wait to get this appointment (before getting to the clinic)
Clear selection
d. The time you had to wait after you arrived at the clinic
Clear selection
e. Getting reminders for your appointment
Clear selection
Comments
Q2. Your experience with reception staff at your last visit
Please rate each statement
a. Were welcoming upon your arrival
Clear selection
b. Were professional in dealing with you
Clear selection
c. Considered your needs when making an appointment
Clear selection
d. Let you know about any delays while you were waiting
Clear selection
e. Were courteous and polite
Clear selection
Comments
Q3. Your experience of the interpersonal skills of the clinician at your last visit
Please rate each statement
a. Treated you with respect
Clear selection
b. Understood your personal circumstances
Clear selection
c. Had enough time to talk about the things that were important for you
Clear selection
d. Showed sensitivity to your concerns
Clear selection
e. Told you all you wanted to know about you condition
Clear selection
Comments
Q4. Your experience of the way clinicians communicated with you at your last visit
Please rate each statement
a. Helped you understand your medical condition
Clear selection
b. Explained the purpose of tests and treatments
Clear selection
c. Involved you in decisions
Clear selection
d. Adequately discussed your personal issues
Clear selection
e. Really listened to what you had to say
Clear selection
Comments
Q5. Your experience of the information given to you by the clinicians at your last visit
Please rate each statement
a. The amount of useful information given about your condition
Clear selection
b. The amount of useful information given about your treatment
Clear selection
c. Information about how to take your medications
Clear selection
d. Information about side effects of any treatment
Clear selection
e. Information about how to stay healthy
Clear selection
f. Information about how to prevent future health problems
Clear selection
Comments
Q6. Your experience of privacy at your last visit
Please rate each statement
a. Privacy in the waiting room
Clear selection
b. Privacy when you were examined
Clear selection
c. Being able to discuss personal issues that were sensitive
Clear selection
d. Your understanding of how medical records are kept private in the clinic
Clear selection
e. The way in which information was given to other clinicians
Clear selection
Comments
Q7. Your experience of the way your clinicians worked with other healthcare professionals at your last visit
Please rate each statement
a. Knew your medical history at the clinic
Clear selection
b. The clinician was aware of advice you had received from other health professions
Clear selection
c. Gave you options for specialist or other health providers you need to see
Clear selection
d. Allowed you to have the final choice about which professionals to see
Clear selection
e. Gave the right amount of information to other healthcare professionals
Clear selection
Comments
Q8. Thinking about your experience with the general practice over the past year
Please rate each statement
a. Suitability of clinic opening hours
Clear selection
b. Being able to see a doctor at the clinic when you need urgent care
Clear selection
c. Being able to see the doctor of your choice
Clear selection
d. Information about where to get medical care when the clinic is closed
Clear selection
e. The amount you paid for each visit to the doctor
Clear selection
Comments
Q9. Thinking about your experiences with the general practice over the past year
Please write your ideas below:
SOME THINGS ABOUT YOU
Q10. Are you?
Clear selection
Q11. Do you consider yourself of Aboriginal and/or Torres Strait Islander descent?
Clear selection
Q12. Have you been to another general practice in the last year?
Clear selection
Q13. Which languages do you speak at home? Tick all spoken
Q14. What is your age?
Clear selection
Q15. How long have you been coming to this practice?
Clear selection
Q16. Do you have any of these concession cards?
Clear selection
Q17. How many times have you visited this practice over the past 12 months?
Clear selection
Q18. What is the highest level of education you have reached?
Clear selection
Q19. Was this visit for yourself or someone you were caring for?
Clear selection
Q20. Are you aware that this practice specialised in Nurse run Chronic Disease Clinics?
Clear selection
Q21. Have you ever received treatment at the Nurse run Chronic Disease Clinic?
Clear selection
Q22. Thinking about your experience of the Nurse run Chronic Disease Clinic at this practice
Please rate the practice on how it
a. Helped you understand your chronic condition
Clear selection
b. Explained the purpose of tests and treatment
Clear selection
c. Involved you in decisions
Clear selection
d. Allowed you to have the final choice about tests
Clear selection
e. Allowed you to have the final choice about treatments
Clear selection
f. Understood how the Chronic condition affected your life
Clear selection
Comments
Thank you for taking the time to complete this questionnaire. Please press 'SUBMIT' below.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms