This is a SURVEY PREVIEW of "Page 1". Do not use this to collect responses - Responses entered will NOT BE SAVED.

We are collecting user feedback to improve the multilingual printable appointment card. It’s a simple online tool developed by Cancer Council Victoria with assistance from Poloron Language Services, who helped to ensure the quality of translations. The tool is available on the Cancer Council Victoria website.

The multilingual printable appointment card was developed to help culturally and linguistically diverse Australians easily access their healthcare appointments. It aims to improve non-English speaking clients' attendances to health care appointments and reduce failure to attend dates.

The tool allows you to fill in your client/patient's appointment details in English and print them in their preferred language. Patients can use the card to locate and remember their next appointment. You can access the current tool here:

Based on feedback received to date, we are investigating several updates to the tool to make it more user-friendly and helpful to your work. This survey outlines the potential changes and will help us determine which updates are most beneficial.

Thank you for your feedback.
What type of healthcare do you or your practice provide?
Have you ever used the multilingual printable appointment card?
If no, why not?
The proposed changes to the current tool are outlined below. Please tick the relevant box to indicate if you think the change would be helpful.
Yes, helpful
No, not helpful
No opinion
Comments (optional)
The ability to upload your logo onto the printed form
The ability to print the card onto your letterhead
Adding location details from Google Maps, including a street view image
A comments box to allow you to add free text in English
The option to email a copy of the card, in addition to printing the card
Adding the appointment type with the following options translated in tick box format: Doctor, Nurse, Refugee Health Nurse, Smoke cessation, Social worker, Physiotherapy, Occupational Therapist, Speech Therapist, Exercise class
We are considering adding the following translated appointment instructions in tick box format (only ticked boxes will appear on the translated appointment card).
Please rate the helpfulness of each instruction with 1 being not at all helpful and 5 being very helpful.
1 - not at all helpful
5 - very helpful
"If you are unable to keep this appointment please contact us.”
“We can provide a letter for school, work or English class if required”
“Gowns can be provided upon request.”
“Please bring your Medicare and Health Care card”
“Please bring details about any medication you are taking”
“Please bring any referral forms, reports or letters given to you by a doctor or another service”
“An interpreter has been arranged”
Would you be more likely to use the tool if the changes are made?
Would you like us to notify you when the update is completed?
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