How Are We Doing?

Thank you for taking the time to fill out our survey. Your feedback will help us learn what we can do to better meet the needs of our patient community. Your survey and comments will be kept in confidence. You may also contact Tim Buckley, the general manager, at tim.buckley@seymourhealth.ca.

Name

Contact number

Email

Ease of scheduling your appointment

Availability, courteous and clear
 Exceeds Expectations Meets Expectations Below Expectations Unsatisfactory N/A

Comments

Reception and Greeting

Name of doctor’s receptionist

Name of front desk receptionist if applicable, and if you are a walk-in patient

You were greeted promptly and in a courteous manner
 Exceeds Expectations Meets Expectations Below Expectations Unsatisfactory N/A

You were brought into the examining room by
 Doctor Nurse Doctor’s Receptionist

Comments

Appointment with doctor/physician

Name of doctor/physician

Quality of time spent, thoroughness, receptiveness to your needs
 Exceeds Expectations Meets Expectations Below Expectations Unsatisfactory N/A

Comments

Confidentiality and comfort

Our concern for your privacy
 Exceeds Expectations Meets Expectations Below Expectations Unsatisfactory N/A

Would you recommend this facility and its staff to your family and friends?
 Yes No N/A

Additional Comments

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