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Survey of Health Facilities Accessed by
Stoney Nakoda & Tsuut’ina Members

Purpose of the Survey

The Stoney Nakoda & Tsuut’ina Elders and Leadership, in partnership with the G4 Health Team, are looking to the community to help in building a brighter future for our peoples’ health by conducting the following survey.  The intent is to share your feedback with our stakeholders to advocate for system changes that are culturally inclusive and safe.

If you have any questions about the survey, please contact:        g4health1@gmail.com
Consent
It is understood that all information collected from the surveys will be aggregated and no First Nation individual will be identifiable in the report.  By completing this survey, I agree for my information to be included as part of the aggregate data set.  I also understand that the First Nation principles of OCAP® are guiding the process, which ensure First Nation Ownership, Control, Access, and Possession of the Information, data sets, and final reports.
Survey Questions:
Please indicate which health facility you are evaluating below; please choose only one facility below.  If you would like to evaluate more than one facility, please complete a new survey.
Have you ever experienced racism in the health facility being evaluated?
If you have experienced racism, which areas of your health have been impacted?  Please check all that apply:
Did the healthcare professionals support your Human Right to access traditional healing?
Would you like to share an experience of racism or discrimination that you faced at this health facility?  (If more space is required, please use the back side of the page)
Will you access this health facility again?
Have you experienced racism in other areas, such as education, employment, etc.?  If so, please check all that apply. 

Pînamach & Siyasgaas

Thank you very much for your feedback and insights.