DRAFT 2 - Return to Healthcare Facility Survey

Q1. Which of the following consultation methods are you comfortable with?

Q2. Ranking the options below from 1 to 6, which of the below are important to you when going back to clinic visits.

Availability and usage of masks
Availability and usage of hand sanitizers
Social distancing measures
Safe waiting areas – distanced seating spaces, frequent sterilization / sanitation
Temperature checks in every area
Assurance of the facility not being overcrowded

Q3. Considering communication methods, rank the options below from 1 to 7, according to your preference.

A general message that the clinic is safe
Online information on the steps being taken by the hospital to ensure patient safety
I would like to have someone contact me to give me reassurances on my return
Safety measures being taken by everyone at the hospital (masks, sanitizers & physical distancing)
If my physician is back, I will be back as well
Nothing of note – I trust my healthcare providers to welcome me back when it is safe to do so
I am not coming back anytime soon