Client Experience Questionnaire

Tell us about your experience!  Your feedback helps us to improve the way we provide services.  This questionnaire was built upon our Patient Values (Dignity, Respect and Trust, Information Sharing, Participation, Accessibility and Responsiveness, and Quality).

We do not collect personal information unless you request a follow-up.

If the question does not apply, please leave blank

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* Is this your first visit to Murray House?

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* Would you consider Murray House in the future if needed?

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* Please indicate the factors that would lead you to chose to stay at Murray House?

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* Murray House Program Related Questions:
(If the question does not apply, please leave blank)

  Strongly Agree Agree Disagree Strongly Disagree
a.  My request to stay at the Murray House was handled in a timely manner.
b.  Murray House is conveniently located.
c.  Check-in was well organized.
d.  I felt the staff were friendly.
e.  I was treated with respect.
f.  My privacy was respected as best it could be.
g.  The staff kept my information confidential and secure.
h.  The staff helped with any concerns/issues during my stay.
i.  My checkout was well organized.
j.  In general, staff were compassionate.

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* k.  Cleanliness of the following areas:

  Always Usually Sometimes Never
a.  Individual Suite
c.  Kitchen
d.  Common Areas (e.g hallways, elevators, laundry room)
e.  Public Washrooms

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* l.  Availability of the following amenities (or services)?

  Always Usually Sometimes Never
a.  Telephones
b.  Wi-Fi
c.  Television

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* m.  Environment:

  Always Usually Sometimes Never
a.  Noise was kept to a minimum
b.  Room temperature was comfortable
c.  I felt safe at the Murray House
d.  I felt safe in my suite
e.  The atmosphere was welcoming
Demographics:   (of the guest(s))

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* Gender:

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* Ethnicity:

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* Age:

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* What is the one thing we could do to improve your stay at the Murray House?

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* Comments:

Murray House Patient Advisor Volunteers Needed!!  Someone just like you helped to design this survey! 
We want to partner with Murray House existing patients who might be interested in helping us review,
design or provide feedback to our services. 
If you are interested in this, please leave your name, phone number and email address below:

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* Volunteer Contact Information:


Forward additional Concerns or Compliments regarding your care to Patient Relations.

Patient Relations:  email  patientrelations@pmh-mb.ca or call  1-800-735-6596

Thank you for your participation!

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