Patient Survey Questionnaire

7/28/2019 Patient Survey Questionnaire

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Dear East Care Patient

1 Tell us about yourself -

Age of patient attending today: 0-5 6-17 18-25 26-35 36-50 51-65 over 65

Gender of patient attending today: male female

Ethnicity: NZ European Chinese South African

European Other Asian Pacific Islander

Maori Indian Other ..

2 Did you attend the clinic today for: yourself your child/ren as a support person

3 Was this your first visit to this facility? yes no

4 Are you enrolled with a Family Doctor? yes no

5 If yes, is this Family Doctor local? yes no not applicable

6 Referral by another patient Telephone Directory

Referral by friend or family member Your own GP after hours phone message or notice

Close to home or work 24 Hour Operation

Street Signage East Care website - www.eastcare.co.nz

Local Papers Radio Advertising

Proximity of support services eg x-ray, laboratory, pharmacy, physiotherapy etc

Other eg sent from Middlemore (specify .)

PATIENT SATISFACTION QUESTIONNAIRE

What factors influenced your choice of this clinic?

Please take a few minutes to tell us how you feel about your latest visit to East Care. This questionnaire is anonymous so

please respond freely. The purpose is to help us improve our services so we would be grateful if you would complete this

questionnaire and return it in the self-addressed envelope provided.


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CUSTOMER FOCUSED SERVICES:

1

2

3

4

5

ACCESSIBILITY:

1

2

3

CONSUMER ASSESSMENT, DIAGNOSIS, TREATMENT AND FOLLOW-UP:

12

3

4

5

6

7

8

9

10

STRONGLY

AGREE AGREE UNCERTAIN

STRONGLY

AGREE

NOT

APPLICABLE

I feel that East Care respected my cultural and/or family needs:

I feel that East Care respected my right to privacy:

STRONGLY

AGREE AGREE UNCERTAIN DISAGREE

STRONGLY

DISAGREE

AGREE UNCERTAIN DISAGREE

DISAGREE

STRONGLY

DISAGREE

NOT

APPLICABLE

STRONGLY

DISAGREE

NOT

APPLICABLE

I feel the staff (doctor and nurse) listened to my concerns/fears/complaints

attentively:

I feel that I was offered a chance to ask questions and be involved in my treatment

and follow-up:

I feel that consideration was given to my culture when choosing treatment and

offering advice:

I am happy with the way my phone calls to East Care were dealt with:

The waiting time in the surgery, to be seen, was reasonable (NOTE: Emergencies

are given medical priority):

I feel that East Care encouraged me to bring support (family/whanau/friends) with

me:

I feel that East Care limits barriers to communication by having interpreters and/or

interpreted material available when needed:

East Care's complaints process is clear and accessible:

It is important to me that East Care is open 24 hours:

I feel the clinic has clear signage and information that describes the scope of

services provided:

I feel there is sufficient parking at East Care:

The reception staff made me feel welcome:I feel the nursing staff were pleasant and professional:

I feel I had adequate time with the doctor:

I am happy with the way my consultation notes are forwarded to my Family Doctor or

Primary Care Provider:

I am happy with the way East Care ensures continuity of care (eg regarding

notification of test results, referral back to GP for follow-up, transfer to

hospital/specialists):


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FACILITIES/FEES:

1

2

3

4

5

6yes no

Word of mouth

Other ...

7 yes no

8

9

ADDITIONAL COMMMENTS:

..

..

..

..

..

reasonable

NZ Herald

STRONGLY

AGREE

Local paper

AGREE

too high

Radio

UNCERTAIN DISAGREE

too low

STRONGLY

DISAGREE

TV

NOT

APPLICABLE

I feel East Care's facilities provide adequate privacy:

I rate this visit as being very satisfactory:

Are you aware of East Care's reduced charges for Under 6's, 65+, Community

Service Card holders, High User cards and those who live in a low income area?

THANK YOU FOR COMPLETING OUR QUESTIONNAIRE

AND HELPING US TO IMPROVE OUR SERVICE

If English is your second language, and you wish to put your comments in your f i rst language we will have your comments translated through our interpretation

services.

Do the new reduced charges at East Care apply to the patient presenting today?

I would recommend East Care A & M to a friend:

I am satisfied with the associated services at East Care (e.g. pharmacy, radiology,

community based Labtests, Specialist Centre, physiotherapy and hand therapists):

If yes, how were you made aware of this? (please circle)

On the basis that East Care has doctors available 24 hours/7 days, do you think the

fees are? (please circle)

What other services would you like to see available within the East Care facility?

The waiting room was clean and comfortable:

Documents

Patient Survey Questionnaire