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Microsoft Word - 24.42 KB]
These questions can be used as a guide to collect feedback as you observe a patient using your portal. Use this form to record responses.
- Is this the first time you have visited our Patient Portal?
___ Yes
___ No
If Yes: Why haven't you used the patient portal before? ______________________________
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- How often do you use the Internet?
___ Every day
___ A few times per week
___ About once per week
___ Less than once per week
___ Never or hardly ever
- Is it clear how to sign in to the patient portal?
___ Yes
___ No. If No, what can we do to make it clearer? _______________________________
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- Does the menu of items on the home page give you the options you need?
___ Yes
___ No. If No, what do you need to do and cannot find on the home page? ___________
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- Do you like how the site looks?
___ Yes
___ No. If No, how could we improve its appearance? ____________________________
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| TO STAFF: Allow the patient to navigate the site. Ask if he or she could show you how to do something the patient is likely to want to do while on the practice portal (for instance, try to request a prescription refill or make an appointment). Once this is done, ask the following questions. |
- Is the information you want on the site?
___ Yes
___ No. If no, what information would you like to have on the site? ________________
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- Is it easy to find the information you want?
___ Yes
___ No. If no, what was hard to find and why? __________________________________
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- Is the information on the site easy to understand?
___ Yes
___ No. If no, what was hard to understand and why? ____________________________
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- Is the information on the site clearly displayed (i.e., easy to see and read)?
___ Yes
___ No. If no, what was unclear and why? _____________________________________
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- Now that we have gone through the patient portal, would you use it again?
___ Yes
___ No. If no, why not? ___________________________________________________
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Use this space to note how easy it was for the patient to perform a task you ask him or her to do (e.g., find information on a particular topic, look up recent lab results, request a prescription refill).
