Physician Survey

Physician Satisfaction Survey


Please download a PDF of the survey and fax or email the completed document to our office


Kitchener-Cambridge Clinic: (fax) 519-579-9371 (email) office@kclsleepcentre.com

London Clinic: (fax) 519-685-7338  (email) london@kclsleepcentre.com


KITCHENER-CAMBRIDGE-LONDON SLEEP CENTRES

Physician Satisfaction Survey

Please indicate facility(ies) being reviewed:______________________________________________

Please answer the following questions regarding your experience with the above facility by filling in the blank or circling the option that best describes your answer.
1. How long have you referred patients to this facility? _____years or _____months
2. How satisfied are you with how long it generally takes:

  •  To get an appointment for a patient at this facility?
    Not Applicable       Very Dissatisfied       Dissatisfied       Neutral Satisfied       Very Satisfied
  • To obtain written results (a written consultation) from this facility, once your patient is seen?                                                                                      Not Applicable       Very Dissatisfied       Dissatisfied       Neutral Satisfied       Very Satisfied

3. Approximately how many patients have you referred to this facility in the past 6 months? #_________
4. Do you refer your patients to more than one facility of this type?          Yes          No
IF YES -What are the reasons you refer patients to this particular facility? (Please circle all that apply.)

A) Near Patient’s home

B) Has specialized equipment needed for tests requested

C) Turnaround time to receive the results is shortest

D) Has staff that speaks other languages, and thus can better understand my patients

E) Is able to quickly see patients when feedback is urgently required

F) Has convenient hours of operation

G) Quality of the services provided

H) Other, please describe ___________________

IF NO – What are the reasons you refer patients only to this facility? (Please circle all that apply.)

A) Has staff that speak other languages and thus can better understand my patients

B) Has specialized equipment needed for tests requested

C) Turn‐around time to receive results is short

D) Has different locations for patient convenience

E) Is able to quickly see patients when feedback is urgently required

F) Quality of the services provided

G) Has convenient hours of operation

H) Other, please describe____________________

5. Please rate each item by circling the number that best describes your experience with the IHF based on your contacts in the last 6 months.

  • The waiting period for a test to be done is long:

Never      Seldom      Sometimes      Frequently      Usually

  • Requests for consultation are handled promptly:

Never      Seldom      Sometimes      Frequently      Usually

  • The facility accommodates patients when the test is urgently required:

Never      Seldom      Sometimes      Frequently      Usually

  • The interpreting physician is available to you for consultation:

Never      Seldom      Sometimes      Frequently      Usually

  • This facility meets the needs of my patients whose first language is other than English or French:

Never Seldom Sometimes Frequently Usually

  • The recommendations received are useful in patient management:

Never      Seldom      Sometimes      Frequently      Usually

  • The recommendations are clearly stated:

Never      Seldom      Sometimes      Frequently      Usually

  • Reports of results are sent out in a timely fashion:

Never      Seldom      Sometimes      Frequently      Usually

  • The interpreting physician’s findings are generally consistent with your clinical findings:

Never      Seldom      Sometimes      Frequently      Usually
6. Have you been dissatisfied with a consult you received from this facility in the past six months?

Circle one:          No       Yes

If Yes, please explain:
__________________________________________________________________________________________________________________________________________________________________________

7. Overall, how satisfied are you with the contacts you have had with this facility in the past six months?

Very Dissatisfied      Dissatisfied      Neutral      Satisfied      Very Satisfied

Thank you for participating in this survey. Please fax or email completed surveys to:
Kitchener-Cambridge Clinics: (fax) 519-579-9371 (email) office@kclsleepcentre.com
London Clinic: (fax) 519-685-7338 (email) london@kclsleepcentre.com