- The last time you were sick or were concerned you had a health problem, how many days did it take from when you first tried to see your Nurse Practitioner to when you actually saw her/him or someone else in their office? 
- Did you get an appointment on the day you wanted or within an acceptable timeframe? 
- When you see your Healthcare Providers, how often do they or someone else in the office...? - Give you an opportunity to ask questions about recommended treatment 
- Involve you as much as you want to be in decisions about your care/treatment 
- Spend enough time with you 
 
- How many times in the past 12 months have you received care from a walk-in clinic or Emergency Department? 
- If you have received care from a walk-in clinic or Emergency Department, what was the reason for the visit? 
 
- Have you been hospitalized in the past 12 months? 
- If yes, did you book a follow-up appointment with this clinic? 
 - (Note: We strongly recommend you book a post-hospital discharge follow-up within 7 days) 
- Do you take prescription medication(s) on an ongoing basis? 
- If yes, in the past 12 months, did you review your medications with your Nurse Practitioner and/or Pharmacist? 
 
- We are a Team-Based healthcare model. Please let us know whom you saw in the past 12 months? Please check ALL that apply. 
- Do you feel you have received comprehensive care by seeing a team of health care professionals? 
- Overall, how would you rate your experience with this clinic? 
- Would you recommend our services to friends or your family? 
- Please list any areas in which our service could be improved or any other comments/suggestions about our clinic.