Parkdale Queen West Community Health Centre 2019 CLIENT EXPERIENCE SURVEY
Thank you for taking the time to fill out this survey. Your responses to the questions will help us improve the care we provide. This survey will take approximately 10 minutes to complete. As you answer these questions, keep in mind the programs and services that you have received over the past year. This may include appointments with staff, groups and workshops, community action groups, advisory groups and committees, etc. Please note:
• Your name does not appear on the survey
• Your answers are kept confidential
• Your specific answers will not be shared with staff
• Your choice to participate in this survey will not affect the services you receive

If you have any questions or need help completing the survey, please speak to a staff member.
Interpretation support is available if you wish to complete the survey in a language other than English.

Your Overall Experiences Visiting Us Over the Last Year
How long have you been using programs or services at Parkdale Queen West CHC?
If you became a client less than 1 year ago, how did you find out about our services?
If applicable, name of hospital, health care organization, or community organization that referred you.
Your answer
Which location do you primarily go to for services?
Which location do you primarily go to for services?
What additional services, programs, workshops and/or events would you like Parkdale Queen West Community Health Centre to offer?
Your answer
I always feel comfortable and welcome at Parkdale Queen West CHC
What can we do to make you feel more comfortable and welcome?
Your answer
The hours and days that Parkdale Queen West CHC is open work well for me
If you answered No, what days and times would work better for you?
Your answer
How would you describe your sense of belonging to your community?
General Questions: How do you rate the following?
Poor
Fair
Good
Very Good
Excellent
The care and services you have received at Parkdale CHC.
Your overall physical health.
Your overall mental health
General Questions: Your response to the following statements
Never
Rarely
Sometimes
Often
Always
Parkdale Queen West CHC has a positive impact on your community.
Parkdale Queen West CHC staff treat you with dignity and respect.
Thinking of your overall experience with our centre, what are …?
Two things done particularly well:
Your answer
Two things that could be improved?
Your answer
Questions about our Health Care Services
Please complete the questions on this page if you have seen a health care provider in the last year or so. This includes any of the following: physician, nurse practitioner, registered nurse, chiropodist, physiotherapist, social worker/therapist, dietitian, psychiatrist, Hep C nurse, Diabetes Education Nurse Educator or Dietitian, or asthma educator.

If you have not seen a health care provider in the last year, please leave this section blank.

Thinking about your most recent visit: On a scale of poor to excellent, how would you rate the following?
Poor
Fair
Good
Very Good
Excellent
The length of time you had to wait in the reception/waiting area.
Your confidence in the health care provider(s) you saw during the visit.
Your confidence that your health information was treated with the level of privacy you expect.
Thinking about the MAIN health care provider you spoke with during the visit, on a scale of poor to excellent, how would you rate this person on the following…?
Poor
Fair
Good
Very Good
Excellent
They listened to your concerns.
They explained things in a way that was easy to understand.
You were able to get services in a language of your choice.
Is there any feedback you would like to share to help us improve the way we provide care?
Your answer
Please fill out the next section only about seeing a doctor or a nurse practitioner in the last year.
I can usually book an appointment within a reasonable amount of time:
The last time you were sick or were concerned you had a health problem…
Same day
Next day
2-5 days
6-10 days
11-19 days
20 or more days
Not applicable (don’t know/ refused)
How many days did it take from when you first tried to see your doctor or nurse practitioner to when you actually SAW your provider or someone else in their office?
When you see your doctor or nurse practitioner, how often do they or someone else in the office…?
Never
Rarely
Sometimes
Often
Always
Give you an opportunity to ask questions about recommended treatment.
Involve you as much as you want to be in decisions about your care and treatment.
Questions about You
What is your age now?
In terms of your sex/gender how do you identify? (Select one)
In what language do you prefer to receive services? (Select one of the following)
Were you born in Canada?
If you were not born in Canada, how long have you lived in Canada?
What is your household’s main source of income?
What was your family’s total income last year?
How many people in your household are supported by this income?
Your answer
Thank you for completing our survey!
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