Patient Feedback Questionnaire

Patient Feedback Questionnaire
Please remember that this is just about the doctor you have seen today.
1. Was the doctor polite and considerate?
2. Did the doctor listen to what you had to say?
3. Did the doctor give you enough opportunity to ask questions?
4. Did the doctor answer all your questions?
5. Did the doctor explain things in a way you could understand?
6. Are you involved as much as you want to be in the decisions about your care and treatment?
7. Did you have confidence in the doctor?
8. Did the doctor respect your views?
9a. If the doctor examined you, did he or she ask your permission?
9b. If the doctor examined you, did he or she respect your privacy and dignity?
10. By the end of the consultation did you feel better able to understand and/or manage your condition and your care?
11. Overall, how satisfied were you with the doctor that you saw?

About you, the patient

Who is filling out this form?
Is English your first language?