Patient feedback questionnaire

Thank you for agreeing to complete our questionnaire.

The questionnaire is voluntary, confidential and anonymous. Your answers cannot be linked to you in any way. Your care will not be affected by completing the questionnaire or if you change your mind and decide not to
complete it.

Please answer every question by placing a tick in the box that most closely matches your answer. If a question does not apply to you, please select ‘N/A’
(not applicable), and if you do not know the answer to a question, please select ‘don’t know’.

There are no right or wrong answers – it is your opinion that is important to us.

If you have any questions, please ask one of our staff members.

Place the completed questionnaire in the box at reception.We appreciate your time and help and look forward to continuing to provide
you with quality healthcare.

Yours faithfully, Management, GPs and staff members at Coonamble Aboriginal Health Service.

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practice, been reception

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

	Poor	Fair	Good	Very good	Excellent	N/A	Don’t Know
Seeing the clinician of your choice	PoorSeeing the clinician of your choice Poor	FairSeeing the clinician of your choice Fair	GoodSeeing the clinician of your choice Good	Very goodSeeing the clinician of your choice Very good	ExcellentSeeing the clinician of your choice Excellent	N/ASeeing the clinician of your choice N/A	Don’t KnowSeeing the clinician of your choice Don’t Know
Getting an appointment for a time that suited you	PoorGetting an appointment for a time that suited you Poor	FairGetting an appointment for a time that suited you Fair	GoodGetting an appointment for a time that suited you Good	Very goodGetting an appointment for a time that suited you Very good	ExcellentGetting an appointment for a time that suited you Excellent	N/AGetting an appointment for a time that suited you N/A	Don’t KnowGetting an appointment for a time that suited you Don’t Know
The time you had to wait after you arrived at the clinic	PoorThe time you had to wait after you arrived at the clinic Poor	FairThe time you had to wait after you arrived at the clinic Fair	GoodThe time you had to wait after you arrived at the clinic Good	Very goodThe time you had to wait after you arrived at the clinic Very good	ExcellentThe time you had to wait after you arrived at the clinic Excellent	N/AThe time you had to wait after you arrived at the clinic N/A	Don’t KnowThe time you had to wait after you arrived at the clinic Don’t Know

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

	Poor	Fair	Good	Very good	Excellent	N/A	Don’t Know
Were welcoming upon your arrival	PoorWere welcoming upon your arrival Poor	FairWere welcoming upon your arrival Fair	GoodWere welcoming upon your arrival Good	Very goodWere welcoming upon your arrival Very good	ExcellentWere welcoming upon your arrival Excellent	N/AWere welcoming upon your arrival N/A	Don’t KnowWere welcoming upon your arrival Don’t Know
Were professional in dealing with you	PoorWere professional in dealing with you Poor	FairWere professional in dealing with you Fair	GoodWere professional in dealing with you Good	Very goodWere professional in dealing with you Very good	ExcellentWere professional in dealing with you Excellent	N/AWere professional in dealing with you N/A	Don’t KnowWere professional in dealing with you Don’t Know
Considered your needs when making an appointment	PoorConsidered your needs when making an appointment Poor	FairConsidered your needs when making an appointment Fair	GoodConsidered your needs when making an appointment Good	Very goodConsidered your needs when making an appointment Very good	ExcellentConsidered your needs when making an appointment Excellent	N/AConsidered your needs when making an appointment N/A	Don’t KnowConsidered your needs when making an appointment Don’t Know

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

	Poor	Fair	Good	Very good	Excellent	N/A	Don’t Know
Treated you with respect	PoorTreated you with respect Poor	FairTreated you with respect Fair	GoodTreated you with respect Good	Very goodTreated you with respect Very good	ExcellentTreated you with respect Excellent	N/ATreated you with respect N/A	Don’t KnowTreated you with respect Don’t Know
Understood your personal circumstances	PoorUnderstood your personal circumstances Poor	FairUnderstood your personal circumstances Fair	GoodUnderstood your personal circumstances Good	Very goodUnderstood your personal circumstances Very good	ExcellentUnderstood your personal circumstances Excellent	N/AUnderstood your personal circumstances N/A	Don’t KnowUnderstood your personal circumstances Don’t Know
Had enough time to talk about the things that were important for you	PoorHad enough time to talk about the things that were important for you Poor	FairHad enough time to talk about the things that were important for you Fair	GoodHad enough time to talk about the things that were important for you Good	Very goodHad enough time to talk about the things that were important for you Very good	ExcellentHad enough time to talk about the things that were important for you Excellent	N/AHad enough time to talk about the things that were important for you N/A	Don’t KnowHad enough time to talk about the things that were important for you Don’t Know

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

	Poor	Fair	Good	Very good	Excellent	N/A	Don’t Know
The clinician had enough time to listen to what you had to say	PoorThe clinician had enough time to listen to what you had to say Poor	FairThe clinician had enough time to listen to what you had to say Fair	GoodThe clinician had enough time to listen to what you had to say Good	Very goodThe clinician had enough time to listen to what you had to say Very good	ExcellentThe clinician had enough time to listen to what you had to say Excellent	N/AThe clinician had enough time to listen to what you had to say N/A	Don’t KnowThe clinician had enough time to listen to what you had to say Don’t Know
Helped you understand your medical condition	PoorHelped you understand your medical condition Poor	FairHelped you understand your medical condition Fair	GoodHelped you understand your medical condition Good	Very goodHelped you understand your medical condition Very good	ExcellentHelped you understand your medical condition Excellent	N/AHelped you understand your medical condition N/A	Don’t KnowHelped you understand your medical condition Don’t Know
Explained the purpose of tests and treatment	PoorExplained the purpose of tests and treatment Poor	FairExplained the purpose of tests and treatment Fair	GoodExplained the purpose of tests and treatment Good	Very goodExplained the purpose of tests and treatment Very good	ExcellentExplained the purpose of tests and treatment Excellent	N/AExplained the purpose of tests and treatment N/A	Don’t KnowExplained the purpose of tests and treatment Don’t Know

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

	Poor	Fair	Good	Very good	Excellent	N/A	Don’t Know
The amount of useful information given about your condition	PoorThe amount of useful information given about your condition Poor	FairThe amount of useful information given about your condition Fair	GoodThe amount of useful information given about your condition Good	Very goodThe amount of useful information given about your condition Very good	ExcellentThe amount of useful information given about your condition Excellent	N/AThe amount of useful information given about your condition N/A	Don’t KnowThe amount of useful information given about your condition Don’t Know
The amount of useful information given about your treatment	PoorThe amount of useful information given about your treatment Poor	FairThe amount of useful information given about your treatment Fair	GoodThe amount of useful information given about your treatment Good	Very goodThe amount of useful information given about your treatment Very good	ExcellentThe amount of useful information given about your treatment Excellent	N/AThe amount of useful information given about your treatment N/A	Don’t KnowThe amount of useful information given about your treatment Don’t Know
Information about how to take your medicines	PoorInformation about how to take your medicines Poor	FairInformation about how to take your medicines Fair	GoodInformation about how to take your medicines Good	Very goodInformation about how to take your medicines Very good	ExcellentInformation about how to take your medicines Excellent	N/AInformation about how to take your medicines N/A	Don’t KnowInformation about how to take your medicines Don’t Know

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

	Poor	Fair	Good	Very good	Excellent	N/A	Don’t Know
Privacy in the waiting area	PoorPrivacy in the waiting area Poor	FairPrivacy in the waiting area Fair	GoodPrivacy in the waiting area Good	Very goodPrivacy in the waiting area Very good	ExcellentPrivacy in the waiting area Excellent	N/APrivacy in the waiting area N/A	Don’t KnowPrivacy in the waiting area Don’t Know
Privacy when you were examined	PoorPrivacy when you were examined Poor	FairPrivacy when you were examined Fair	GoodPrivacy when you were examined Good	Very goodPrivacy when you were examined Very good	ExcellentPrivacy when you were examined Excellent	N/APrivacy when you were examined N/A	Don’t KnowPrivacy when you were examined Don’t Know
Being able to discuss personal issues that were sensitive	PoorBeing able to discuss personal issues that were sensitive Poor	FairBeing able to discuss personal issues that were sensitive Fair	GoodBeing able to discuss personal issues that were sensitive Good	Very goodBeing able to discuss personal issues that were sensitive Very good	ExcellentBeing able to discuss personal issues that were sensitive Excellent	N/ABeing able to discuss personal issues that were sensitive N/A	Don’t KnowBeing able to discuss personal issues that were sensitive Don’t Know

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

	Poor	Fair	Good	Very good	Excellent	N/A	Don’t Know
Knew your medical history at the clinic	PoorKnew your medical history at the clinic Poor	FairKnew your medical history at the clinic Fair	GoodKnew your medical history at the clinic Good	Very goodKnew your medical history at the clinic Very good	ExcellentKnew your medical history at the clinic Excellent	N/AKnew your medical history at the clinic N/A	Don’t KnowKnew your medical history at the clinic Don’t Know
The clinician was aware of advice you had received from other health professionals	PoorThe clinician was aware of advice you had received from other health professionals Poor	FairThe clinician was aware of advice you had received from other health professionals Fair	GoodThe clinician was aware of advice you had received from other health professionals Good	Very goodThe clinician was aware of advice you had received from other health professionals Very good	ExcellentThe clinician was aware of advice you had received from other health professionals Excellent	N/AThe clinician was aware of advice you had received from other health professionals N/A	Don’t KnowThe clinician was aware of advice you had received from other health professionals Don’t Know
Gave you options for specialists or other health providers you need to see	PoorGave you options for specialists or other health providers you need to see Poor	FairGave you options for specialists or other health providers you need to see Fair	GoodGave you options for specialists or other health providers you need to see Good	Very goodGave you options for specialists or other health providers you need to see Very good	ExcellentGave you options for specialists or other health providers you need to see Excellent	N/AGave you options for specialists or other health providers you need to see N/A	Don’t KnowGave you options for specialists or other health providers you need to see Don’t Know

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

	Poor	Fair	Good	Very good	Excellent	N/A	Don’t Know
Suitability of clinic opening hours	PoorSuitability of clinic opening hours Poor	FairSuitability of clinic opening hours Fair	GoodSuitability of clinic opening hours Good	Very goodSuitability of clinic opening hours Very good	ExcellentSuitability of clinic opening hours Excellent	N/ASuitability of clinic opening hours N/A	Don’t KnowSuitability of clinic opening hours Don’t Know
Being able to see a doctor at the clinic when you needed urgent care	PoorBeing able to see a doctor at the clinic when you needed urgent care Poor	FairBeing able to see a doctor at the clinic when you needed urgent care Fair	GoodBeing able to see a doctor at the clinic when you needed urgent care Good	Very goodBeing able to see a doctor at the clinic when you needed urgent care Very good	ExcellentBeing able to see a doctor at the clinic when you needed urgent care Excellent	N/ABeing able to see a doctor at the clinic when you needed urgent care N/A	Don’t KnowBeing able to see a doctor at the clinic when you needed urgent care Don’t Know
Being able to see the doctor of your choice	PoorBeing able to see the doctor of your choice Poor	FairBeing able to see the doctor of your choice Fair	GoodBeing able to see the doctor of your choice Good	Very goodBeing able to see the doctor of your choice Very good	ExcellentBeing able to see the doctor of your choice Excellent	N/ABeing able to see the doctor of your choice N/A	Don’t KnowBeing able to see the doctor of your choice Don’t Know

Do you have any comments you would like to make about your experience with the general practice over the last year?

Q9. If you could change one thing about the practice, what would you change?

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