Client Feedback Survey

8% of survey complete.

SHORE Centre is committed to ensuring that patients are satisfied with the care that they receive from our staff and clinicians.

We value your feedback and use it to help improve the services we offer. This survey includes questions related to the collection of race-based data that supports us in understanding the diversity of our clients and helps measure inequities that exist in healthcare.

This survey is voluntary. If you decide not to participate, it will not affect the type of care that you receive at SHORE Centre.

Question Title

* 1. How do you identify your ethnic origin? (select all that apply)

North American Indigenous origins

Other North American origins

European origins

Caribbean origins

Latin, Central and South American origins

African origins

Asian origins

Oceania origins

Do not know

Prefer not to answer

Question Title

* 2. Which best describes you? (select all that apply)

Black

East/Southeast Asian

Indigenous (First Nations, Metis, Inuk/Inuit)

Latinx

Middle Eastern

South Asian

White

Do not know

Prefer not to answer

Another category(please specify)

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* 3. What is your age range?

14 and Under

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55+

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* 4. What is your gender?

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* 5. Are you 2SLGBTQ+?

Yes

Prefer not to answer

Client Feedback Survey

Question Title

* 1. How do you identify your ethnic origin? (select all that apply)

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* 2. Which best describes you? (select all that apply)

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* 3. What is your age range?

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* 4. What is your gender?

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* 5. Are you 2SLGBTQ+?

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* 6. If you selected "Yes" and if you are comfortable, please provide more details below.

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* 7. What language(s) do you speak?

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* 8. Are you a person living with a disability?