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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

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