Patient Satisfaction Survey


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

    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:

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