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To: Selected Patients of Doctor

Date:

Listed below are a number of statements about your medical care. Think about the

medical care you have received from the doctor who sent you this questionnaire.

Please

check

the answer that best corresponds to your feelings:

1. I understand my doctor’s instructions to me.

¨

Always

¨

Mostly

¨

Occasionally

¨

Never

¨

Not Applicable

2. My doctor explains my health problems.

¨

Always

¨

Mostly

¨

Occasionally

¨

Never

¨

Not Applicable

4. My doctor’s explanations are clear and understandable.

¨

Always

¨

Mostly

¨

Occasionally

¨

Never

¨

Not Applicable

6. When I have medical tests, my doctor explains how I will get the results.

¨

Always

¨

Mostly

¨

Occasionally

¨

Never

¨

Not Applicable

8. My doctor treats me with respect.

¨

Always

¨

Mostly

¨

Occasionally

¨

Never

¨

Not Applicable

10.My

doctor is too businesslike and impersonal with me.

¨

Always

¨

Mostly

¨

Occasionally

¨

Never

¨

Not Applicable

12.My

doctor spends enough time with me.

¨

Always

¨

Mostly

¨

Occasionally

¨

Never

¨

Not Applicable

14.Before deciding what is wrong with me, my doctor talks to me and/or examines

me.

¨

Always

¨

Mostly

¨

Occasionally

¨

Never

¨

Not Applicable

16.My

doctor takes my health problems seriously.

¨

Always

¨

Mostly

¨

Occasionally

¨

Never

¨

Not Applicable

18.My

doctor does his or her best to keep me from worrying needlessly about my

health.

¨

Always

¨

Mostly

¨

Occasionally

¨

Never

¨

Not Applicable

20.It

takes too long to get an appointment with my doctor.

¨

Always

¨

Mostly

¨

Occasionally

¨

Never

¨

Not Applicable

5.b Patient

Questionnaire

Q-1

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P

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P.E.P.

For

Saskatchewan

Physicians

Phone: (306)-966-7793

FAX:

(306)-966-7673

Practice

Enhancement

Program

CME, University of Saskatchewan

Box 60001RPO Univeristy

Saskatoon, SK S7N 4J8