Patient Satisfaction Survey

Please rate the following about your visit to this clinic in terms of whether they were Poor (1), Fair (2), Good (3), Excellent (4), or Not Applicable / No Opinion (8). Your responses will be kept completely confidential.

If your situation requires additional review, please refer to our Feedback & Complaint Process.

    Personal Information:

    Date of Visit

    First Name

    Last Name

    Phone Number

    Email Address

    Waiting Time:

    1. How long you had to wait to get an appointment at this clinic

    2. How long you had to wait in the clinic waiting room for your appointment

    Instructions:

    3. How well the clinic staff (doctors, receptionists, technologists, etc.) told you how to prepare for the test(s) and what to expect both before and/or during the test(s)

    Ease of Getting Information:

    4. Willingness of clinic staff to answer your questions

    5. Information you were given: how clear and complete the explanations were about any possible risks and complications of the test(s)

    Concern & Caring by Clinic Staff:

    6. Courtesy and respect, you were given, friendliness and kindness; how well clinic staff listened to what you had to say; how well the clinic staff understood what you thought was important

    Safety & Security:

    7. The provisions for your safety and the security of your belongings

    Privacy:

    8. How well your privacy was considered, for example, type of gowns used, privacy while changing clothes

    Experience:

    9. Instructions on leaving: how clearly and completely you were told what to do and what to expect when you left the clinic

    10. Were you told to leave the clinic before you felt ready to do so?

    11. Did you have to visit a physician, walk-in clinic, emergency room, urgent care centre or hospital in the days following this service because your health got worse as a result of the service(s) received at the clinic?

    12. Would you recommend the clinic to a friend or family member if they needed services that it provides?

    13. Overall quality of care: How would you evaluate the services you received and the way you were treated?

    14. If there were some things you could change about this visit to improve it, what would they be?

    Press the "Submit" button below to complete the survey. Your responses will be kept completely confidential. Thank you for helping us to improve.