GPHP Echocardiogram Patient Survey

Your Visit

Having been seen for an echocardiogram at a GP Health Partners' Clinic recently, we would be grateful if you could answer a few questions about the care you received to assist us with ongoing evaluation and review. All responses will remain confidential. We thank you for your time in completing this. Please note, wait times of 4-6 weeks for echo are expected and in line with our contract.

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* 1. Do you feel you received an appointment in a timely fashion?

Agree

Neutral

Disagree

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* 2. Please rate the following

	Poor	Needs Improvement	Acceptable	Good	Excellent
Communication about the appointment	Communication about the appointment Poor	Communication about the appointment Needs Improvement	Communication about the appointment Acceptable	Communication about the appointment Good	Communication about the appointment Excellent
Information about where to find the clinic	Information about where to find the clinic Poor	Information about where to find the clinic Needs Improvement	Information about where to find the clinic Acceptable	Information about where to find the clinic Good	Information about where to find the clinic Excellent
Helpfulness of reception team	Helpfulness of reception team Poor	Helpfulness of reception team Needs Improvement	Helpfulness of reception team Acceptable	Helpfulness of reception team Good	Helpfulness of reception team Excellent
Appointment reminder text	Appointment reminder text Poor	Appointment reminder text Needs Improvement	Appointment reminder text Acceptable	Appointment reminder text Good	Appointment reminder text Excellent
Please rate the care by the echo technician	Please rate the care by the echo technician Poor	Please rate the care by the echo technician Needs Improvement	Please rate the care by the echo technician Acceptable	Please rate the care by the echo technician Good	Please rate the care by the echo technician Excellent

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* 3. During your appointment, did the echo technician provide appropriate information relating to the procedure itself?

Agree

Neutral

Disagree

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* 4. Do you feel your privacy and dignity were respected?

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

If you disagree, please state why

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* 5. Please rate the appearance & cleanliness of the waiting room & consultation room

Very Poor

Adequate

Good

Very Good

Excellent

Very Poor

Adequate

Good

Very Good

Excellent

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* 6. Do you feel more comfortable being seen in a community setting rather than a hospital environment?

I'm more comfortable in a community clinic

I prefer to be seen in a hospital setting

It makes no difference to me

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* 1. Do you feel you received an appointment in a timely fashion?

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* 2. Please rate the following

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* 3. During your appointment, did the echo technician provide appropriate information relating to the procedure itself?

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* 4. Do you feel your privacy and dignity were respected?

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* 5. Please rate the appearance & cleanliness of the waiting room & consultation room

Question Title

* 6. Do you feel more comfortable being seen in a community setting rather than a hospital environment?

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* 7. Do you have any other comments, questions, or concerns?