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Home
/ Physician Wellness Program Survey
Physician Wellness Program Survey
PWP Survey
This survey is completely confidential. If you are completing this survey, you do not need to submit a paper survey. The information collected on this form is useful for OCMS to know how to best provide services to our members.
Who was your counselor?
*
Accessing the program and getting set up with the counselor went well.
*
Yes
No
The counselor was able to offer me an appointment time the worked for me.
*
Yes
No
The location was convenient.
*
Yes
No
The counselor was easy to talk to.
*
Yes
No
My meetings with this counselor have been helpful
*
Yes
No
I plan to continue seeing this counselor.
*
Yes
No
If no:
Was not satisfied with visit
Services no longer needed
I would recommend this counselor to my colleagues or patients.
*
Yes
No
I am confident that confidentiality is being maintained.
*
Yes
No
Unsure
The issue that I sought help for is better, or I see a way to improve it as a result of this program
*
Yes
No
Unsure
The issue(s) that I sought help for were (select all that apply):
*
Burnout Prevention
Fear of malpractice/medical error
Relational health (family, friends, community)
Practice Management/Practice Demands
Mindfulness
Anxiety
Stress
Addiction to work
Addiction to substances/substance abuse
Workplace conflict
Finding meaning in practicing medicine
Other (please explain
If other:
Comments or suggestions for the Physician Wellness Program:
*
Number of Sessions Provided
*
Please enter a number from
0
to
50
.
What is your age?
*
25-45
45-65
65+
How do you identify? Select other to self-describe.
*
Male
Female
Non-Binary
Today's Date
*
MM slash DD slash YYYY
Δ
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