Patient Experience Questionnaire – Moss Street Medical

Q1. Making an appointment and waiting to see a clinician at your last visit (please rate each statement)

a) The time you had to wait to get this appointment (before getting to the clinic)

Poor

Fair

Good

Very Good

Excellent

N/A

Don't Know

b) The time you had to wait after you arrived at the clinic

Poor

Fair

Good

Very Good

Excellent

N/A

Don't know

c) Getting reminders for your appointment

Poor

Fair

Good

Very Good

Excellent

N/A

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 (please rate each statement)

a) Were welcoming upon your arrival

Poor

Fair

Good

Very Good

Excellent

N/A

Don't know

b) Considered your needs when making an appointment

Poor

Fair

Good

Very Good

Excellent

N/A

Don't know

c) Were courteous and polite

Poor

Fair

Good

Very Good

Excellent

N/A

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 (please rate each statement)

a) Had enough time to talk about the things that were important for you

Poor

Fair

Good

Very Good

Excellent

N/A

Don't know

b) Showed sensitivity to your concerns

Poor

Fair

Good

Very Good

Excellent

N/A

Don't know

c) Understood your personal circumstances

Poor

Fair

Good

Very Good

Excellent

N/A

Don't know

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

Q4. Your experience of the way clinicians communicated with you at your last visit (please rate each statement)

a) Helped you understand your medical condition

Poor

Fair

Good

Very Good

Excellent

N/A

Don't know

b) Explained the purpose of tests and treatment

Poor

Fair

Good

Very Good

Excellent

N/A

Don't know

c) Involved you in decisions

Poor

Fair

Good

Very Good

Excellent

N/A

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 your clinicians at your last visit (please rate each statement)

a) The amount of useful information given about your condition

Poor

Fair

Good

Very Good

Excellent

N/A

Don't know

b) Gave you useful written information

Poor

Fair

Good

Very Good

Excellent

N/A

Don't know

c) Told you where to find reliable information on the internat

Poor

Fair

Good

Very Goo

Excellent

N/A

Don't know

d) Information about how to prevent future health problems

Poor

Fair

Good

Very Good

Excellent

N/A

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 (please rate each statement)

a) Privacy when you were examined

Poor

Fair

Good

Very Good

Excellent

N/A

Don't know

b) Being able to discuss personal issues that were sensitive

Poor

Fair

Good

Very Good

Excellent

N/A

Don't know

c) Your understanding of how medical records are kept private in the clinic

Poor

Fair

Good

Very Good

Excellent

N/A

Don't know

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

Q7. Your experience of the way your clinician worked with other healthcare professionals at your last visit (please rate each statement)

a) Knew your medical history at the clinic

Poor

Fair

Good

Very Good

Excellent

N/A

Don't know

b) Gave you options for specialists or other health providers you need to see

Poor

Fair

Good

Very Good

Excellent

N/A

Don't know

c) Allowed you to have the final choice about which other professionals to see

Poor

Fair

Good

Very Good

Excellent

N/A

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 (please rate each statement)

a) Being able to see the doctor of your choice

Poor

Fair

Good

Very Good

Excellent

N/A

Don't know

b) Being able to see a doctor at the clinic when you needed urgent care

Poor

Fair

Good

Very Goo

Excellent

N/A

Don't know

c) Suitability of clinic opening hours

Poor

Fair

Good

Very Good

Excellent

N/A

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?

Please write your ideas below:

Some things about you

Are you?

Male

Female

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

Yes

What is your age?

15 - 24 years

25 - 44 years

45 - 64 years

65 years or over

Don't wish to say

How long have you been coming to this practice?

Less than 1 year

1 - 2 years

3 years or more

Not sure

How many times have you visited this practice over the past 12 months?

Only this visit

2 - 5

6 - 10

11 or more

Not sure

Was this visit for yourself or someone you are caring for?

Self

Someone else

Do you consider yourself to be of Aboriginal and/or Torres Strait Islander descent?

Yes

Which languages do you speak at home? (Tick all spoken)

English

Arabic

Cantonese

Mandarin

Vietnamese

Hindi

Greek

Other

Do you have any of these concession cards?

Health Care Card

Pensioner Concession Card

Any Veterans' Affairs treatment card

Not covered by any concession card

What is the highest level of education you have reached?

Some high school

Completed high school

Currently studying for a higher degree

Completed a trade or technical qualification

Completed a degree or diploma

Postgraduate degree