Please rate the following about your visit to this clinic in terms of
whether they were poor, fair, good, very good, or excellent.
1. Waiting Time - How long you had to wait to get an appointment at this
2. Waiting Time - How long you had to wait in the clinic, waiting for
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)
4. Ease of getting information: willingness of clinic staff to answer
5. Information you were given: how clear and complete the explanations
were about any possible risks and complications of the test(s)
6. Concern and caring by clinic staff: 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.
7. Safety and security:the provisions for your safety and the security
of your belongings
8. Privacy: how well your privacy was considered, for example, type of
gowns used, privacy while changing clothes
9. Instructions on leaving: how clearly and completely you were told what
to do and what to expect when you left the clinic
Please answer the following questions by checking 1 for YES or 2 for NO
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?
Please rate this item by selecting the number that best describes your
13. Overall quality of care: how 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?