[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? ______________________________
___________________________________________________________________________
___________________________________________________________________________
- 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? _______________________________
________________________________________________________________________
________________________________________________________________________
- 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? ___________
________________________________________________________________________
________________________________________________________________________
- Do you like how the site looks?
___ Yes
___ No. If No, how could we improve its appearance? ____________________________
________________________________________________________________________
________________________________________________________________________
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? ________________
________________________________________________________________________
- Is it easy to find the information you want?
___ Yes
___ No. If no, what was hard to find and why? __________________________________
________________________________________________________________________
________________________________________________________________________
- Is the information on the site easy to understand?
___ Yes
___ No. If no, what was hard to understand and why? ____________________________
________________________________________________________________________
________________________________________________________________________
- Is the information on the site clearly displayed (i.e., easy to see and read)?
___ Yes
___ No. If no, what was unclear and why? _____________________________________
________________________________________________________________________
________________________________________________________________________
- Now that we have gone through the patient portal, would you use it again?
___ Yes
___ No. If no, why not? ___________________________________________________
________________________________________________________________________
________________________________________________________________________
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).