Patient Satisfaction Survey

Please help us to serve you better by completing this survey. It should take around 5 minutes to complete.

Your Name (optional)

Your Email (optional)

Program Evaluation

On a scale of 1 - 4 please rate the following

• Wait time before starting cardiac rehabilitation

  PoorFairGoodExcellent

• Duration of the program (6 months)

  PoorFairGoodExcellent

• Program facilities (accessible, clean, functional)

  PoorFairGoodExcellentN/A

• Professionalism and knowledge displayed by program staff

  PoorFairGoodExcellent

• Access to additional resources (dietitian, certified tobacco educator, community resources – Diabetes Education, etc.)

  PoorFairGoodExcellent

• Helpfulness of program volunteers

  PoorFairGoodExcellentN/A

• Content of weekly in-class education sessions

  PoorFairGoodExcellent

• Content of educational handouts

  PoorFairGoodExcellent

• Overall program satisfaction

  PoorFairGoodExcellent

Personal Achievements

On a scale of 1 - 4 please rate the following

• Improvement in exercise endurance

  N/AUnsatisfiedSomewhat SatisfiedSatisfied

• Improvement in ability to perform activities of daily living

  N/AUnsatisfiedSomewhat SatisfiedSatisfied

• Improvement in self-confidence

  N/AUnsatisfiedSomewhat SatisfiedSatisfied

• Improvement in knowledge of how to modify risk factors for cardiovascular disease

  N/AUnsatisfiedSomewhat SatisfiedSatisfied

• Improvement in satisfaction of social activities

  N/AUnsatisfiedSomewhat SatisfiedSatisfied

• Improvement in satisfaction of recreational activities

  N/AUnsatisfiedSomewhat SatisfiedSatisfied

Change in Cardiovascular Disease Risk Factors

On a scale of 1 - 4 please rate the following

• Waist measurement

  N/AUnsatisfiedSomewhat SatisfiedSatisfied

• Cholesterol

  N/AUnsatisfiedSomewhat SatisfiedSatisfied

• Diabetes

  N/AUnsatisfiedSomewhat SatisfiedSatisfied

• Blood pressure

  N/AUnsatisfiedSomewhat SatisfiedSatisfied

• Eating habits and dietary intake

  N/AUnsatisfiedSomewhat SatisfiedSatisfied

• Smoking

  N/AUnsatisfiedSomewhat SatisfiedSatisfied

• Stress and coping behaviours

  N/AUnsatisfiedSomewhat SatisfiedSatisfied

• Active Lifestyle

  N/AUnsatisfiedSomewhat SatisfiedSatisfied

Please make any additional comments and/or suggestions below: