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Locum Evaluation of Placement
To help improve the service we provide, please rate your experience with NZLocums & NZMedJobs.
Your Details
Full Name
(Required)
First
Last
Practice Name
(Required)
Practice Name
Date worked from
(Required)
DD slash MM slash YYYY
Date worked to
(Required)
DD slash MM slash YYYY
Email
(Required)
Did the practice provide a thorough orientation at the beginning of your placement?
Yes
No
Comment
Did the practice provide you with a practice profile?
Yes
No
Comment
Did the practice prepare you to deliver culturally appropriate services to the patients at the practice?
Yes
No
Comment
Did you feel welcomed and well supported in your first weeks at the practice?
Yes
No
Comment
How adequate was the practice in the following areas? Please rate your experience by selecting the most relevant category.
Practice process and protocols
Poor
Adequate
Good
Excellent
Computer system and notes
Poor
Adequate
Good
Excellent
How well was the practice set up to support Māori patients and other ethnic groups?
Poor
Adequate
Good
Excellent
How well were you supported by the practice GPs?
Poor
Adequate
Good
Excellent
How well were you supported by other practice staff?
Poor
Adequate
Good
Excellent
Comment on above if ‘Poor’ is selected and any information we may need to be made aware of
Were you asked to undertake any work that was not agreed to in your contract?
Yes
No
Comment
Did you feel the workload was manageable?
Yes
No
Comment
Did the practice provide you with a vehicle of an appropriate standard?
Yes
No
Comment
Would you recommend this practice to other locums?
Yes
No
Comment
If you would like to provide a testimonial about this practice, please do so here (optional). By doing so you give your consent for us to share this via our marketing literature.
How could NZLocums have improved our services?
Any other comments not covered above.
CONFIDENTIALITY & PRIVACY
The Privacy Act (1993) requires that I ask you the following questions.
Although the information in this evaluation report is not automatically released to the practice, do you give your permission to release the information in this report to the practice if requested?
Yes
No
Do you give your permission to release the information in this report to third parties should this be requested by the practice?
Yes
No
Signature (please type your name)
(Required)
Date
(Required)
MM slash DD slash YYYY
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