Hamilton Vascular Clinic
Experience of Care Survey

This Patient Experience of Care Survey is to help the doctor understand your experience in the clinic on your last visit. Thank you for taking the time to complete this survey.

* indicates required field

Physician's Name:*

Your Email:*

Did this doctor listen carefully to you?:*

Yes
Somewhat
No

Did this doctor explain things in a way that was easy to understand?*

Yes
Somewhat
No

Did this doctor tell you what your medical problem was?:*

Yes
Somewhat
No

Did this doctor tell you the results of any medical tests or x-rays?*

Yes
Somewhat
No
N/A didn't have any tests done

Did this doctor tell you how to improve your medical condition?*

Yes
Somewhat
No

Did this doctor ask about your preferences for treatment choices?*

Yes
Somewhat
No
N/A

Did this doctor ask about your known medical conditions, medications, or allergies?*

Yes
Somewhat
No

Did this doctor spend enough time with you?*

Yes
Somewhat
No

Did this doctor show you respect and treat you with dignity?*

Yes
Somewhat
No

Did this doctor ask if you had any questions?*

Yes
Somewhat
No

Did this doctor ask you about your pain?*

Yes
Somewhat
No
N/A

Please provide any additional comments that you would like us to know.

Additional Comments:

Hamilton Vascular Clinic Experience of Care Survey

Hamilton Vascular Clinic
Experience of Care Survey