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Clinic Location

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Clinic Location

1. I received clear instructions to prepare for my appointment:

Yes
No
N/A

2. The clinic was easy to find:

Yes
No
N/A

3. The clinic was clean and comfortable:

Yes
No
N/A

4. The administrative staff welcomed me upon arrival and assisted me in a timely manner:

Yes
No
N/A

5. The technologist(s) were friendly, professional, and answered my questions:

Yes
No
N/A

6. The overall experience met or exceeded my expectations:

Yes
No
N/A

7. I would recommend myhealth centre to a friend or relative:

Yes
No
N/A

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Specialty (Optional)

How did you hear about MyHealth Centre?

By submitting this form, I agree to receive periodic E-mails about your free CME webinars, and the latest information about your services. I can unsubscribe at any time.

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1. Rate your experience using the myhealth centre app to book or manage your appointment:

worst
2
3
4
5

2. Rate myhealth centre on our ability to provide you with an appointment in a timely manner:

worst
2
3
4
5

3. Rate your myhealth centre's cleanliness and comfort:

worst
2
3
4
5

4. Rate your myhealth centre's staff:

worst
2
3
4
5

5. Rate your overall experience with myhealth centre:

worst
2
3
4
5

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Specialty (Optional)

How did you hear about MyHealth Centre?

By submitting this form, I agree to receive periodic E-mails about your free CME webinars, and the latest information about your services. I can unsubscribe at any time.

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Please select your MyHealth Centre location

1. Are you satisfied with the way the appointments are arranged?

Yes
No

2. Are your phone calls attended to promptly and courteously?

Yes
No

3. Is the requisition easy to follow?

Yes
No

4. Are the reports concise and comprehensive?

Yes
No

5. Are the reports received in a timely manner?

Yes
No

6. Do you find our locations and office hours to be convenient?

Yes
No

7. Overall, have we met or exceeded your expectations?

Yes
No

8. How likely will you continue referring your patients to MyHealth Centre?

Not Likely
Unsure
Possibly
Most Likely

9. Would you recommend MyHealth Centre to a colleague?

Not Likely
Unsure
Possibly
Most Likely

10. Which EMR do you work with?

Accuro
HRM
Oscar
PS Suite
Velox
VSAPP
Other

11. How did you refer your patient(s) to us?

Referral Pad
EMR
Fax
Email

12. How did you hear about MyHealth Centre?

yes

By submitting this form, I agree to receive periodic E-mails about your free CME webinars, and the latest information about your services. I can unsubscribe at any time.

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Patient Name

Or upload a picture of your Ontario Health Card

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