Clone of Patient Feedback Form - Tom Price Medical Centre

Patient Feedback Survey

Thank you for visiting the Paraburdoo Medical Centre. Your feedback matters! Help us improve your healthcare experience by taking a moment to complete our Patient Feedback Survey. Your valuable insights will make a difference in providing you with the best care possible.

Q1. Making an appointment and waiting to see a clinician at your last visit *

Rows	Poor	Fair	Good	Very Good	Excellent	N/A	Don't know
Getting an appointment for a time that suited you
The time you spent travelling to the clinic
The time you had to wait after you arrived at the clinic
Getting reminders for your appointment
The comfort of the waiting room
Ease of parking

Do you have any comments you would like to make about making an appointment and waiting to see a clinician?

Q2. Your experience with reception staff at your last visit*

Rows	Poor	Fair	Good	Very Good	Excellent	N/A	Don't know
Were welcoming upon your arrival
Were professional in dealing with you
Considered your needs when making an appointment
Let you know about any delays while you were waiting
Were courteous and polite
Catered for children

Do you have any comments you would like to make about your experience with reception staff at your last visit?

Q3. Your experience of the interpersonal skills of the clinician at your last visit*

Rows	Poor	Fair	Good	Very Good	Excellent	N/A	Don't know
Treated you with respect
Understood your personal circumstances
Cared about you as a person
Made you feel comfortable
Showed sensitivity to your concerns
Told you all you wanted to know about your condition
Let you talk about alternative therapies you were using

Do you have any comments you would like to make about your experience with clinical staff at your last visit?

Q4. Your experience of the way clinicians communicated with you at your last visit*

Rows	Poor	Fair	Good	Very Good	Excellent	N/A	Don't know
The clinician had enough time to listen to what you had to say
Helped you understand your medical condition
Explained the purpose of tests and treatment
Involved you in decisions
Accepted your decision to seek alternative treatment
Adequately discussed your personal issues
Guided you on how to take medicines correctly
Allowed you to have final choice about treatments
Really listened to what you had to say

Do you have any comments you would like to make about the way clinicians communicated with you at your last visit?

Q5. Your experience of the information given to you by clinicians at your last visit*

Rows	Poor	Fair	Good	Very good	Excellent	N/A	Don't know
The amount of useful information given about your condition
The amount of useful information given about your treatment
Information about how to take your medicines
Information about side effects of any treatment
Information about how to stay healthy
Information about how to prevent future health problems

Do you have any comments you would like to make about the information given to you by clinicians at your last visit?

Q6. Your experience of privacy at your last visit*

Rows	Poor	Fair	Good	Very good	Excellent	N/A	Don't know
Privacy in the waiting area
Privacy when you were examined
Being able to discuss personal issues that were sensitive
The way in which information was given to other clinicians
Your understanding how medical records are kept private in the clinic
The way the electronic records were explained to you
Asked your permission before another clinician came to the appointment

Do you have any comments you would like to make about your experiences of privacy at your last visit?

Q7. Your experience of the way your clinician worked with other healthcare professionals at your last visit*

Rows	Poor	Fair	Good	Very good	Excellent	N/A	Don't know
Knew your medical history at the clinic
The clinician was aware of advice you had received from other health professionals
Gave you options for specialists or other health providers you need to see
Coordinated different healthcare
Gave the right amount of information to other healthcare professionals

Do you have any comments you would like to make about the way your clinician worked with other healthcare professionals at your last visit?

Q8. Thinking about your experience with the general practice over the past year*

Rows	Poor	Fair	Good	Very good	Excellent	N/A	Don't know
Suitability of clinic opening hours
Being able to see the doctor of your choice
Information about where to get medical care when the clinic is closed
The amount you paid for each visit to the doctor
Being able to receive a home visit by a doctor
Providing your test results in an understandable way

Do you have any comments you would like to make about your experience with the general practice over the past year
If you could change one thing about this practice, what would you change?
Thank you for taking the time to complete this questionnaire.
Patient Demographics
How do you describe your gender? (If you use a different term please select other and specify)*

Man or maleWoman or femaleNon-binaryPrefer not to answerOther
Do you consider yourself to be of Aboriginal and/or Torres Strait Islander descent?*

YesNo
What is your age?*

15-24 years25-44 years45-64 years65 years or overDon't wish to say
Which languages do you speak at home? (tick all that apply)*

EnglishArabicCantoneseMandarinVietnameseHindiGreekOther
Have you been to another general practice in the last year?*

YesNo
How long have you been coming to this practice?*

Less than 1 year1-2 years3 years or moreNot sure
How many times have you visited this practice over the last 12 months?*

Only this visit2-56-1011 or moreNot sure
Was this visit for yourself or someone you are caring for?*

SelfSomeone else
Do you have any of these concession cards?*

Health Care CardPensioner Concession CardAny Veterans' Affairs treatment entitlement cardNot covered by any concession card
What is the highest level of education youhave reached?*

Some high schoolCompleted high schoolCurrently studying for a degree or diplomaCompleted a trade or technical qualificationCompleted a degree or diplomaPostgraduate degree
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Patient Feedback Survey