Community Feedback on the Central West Network of Specialized Care Survey

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* 1. How did your hear about the Network of Specialized Care?

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* 2. What are the most common reasons you contact the CW Network office? (check all that apply)

Educational/training event information

Clinical consultations with Dr. Rao

Clinical consultations with the Coordinator &/or Health Care Facilitator

Justice referral/inquiry

Case conference invitation

Updating information on an individual

Other (please specify)

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* 3. If applicable, please check off which sector you work in:

Developmental Services

Mental Health

Health

Justice

Long Term Care

If other please specify:

Other:

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* 4. What region do you or your organization operate in? (check all that apply)

Dufferin

Halton

Peel

Waterloo

Wellington

If other, please specify below:

Other:

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* 5. If applicable, please check off which position you hold in your organization:

Executive Director

Director of Services

Manager

Supervisor

Front line staff

If Other, please specify below

Other:

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* 6. How would you rank the CW Network on the following questions, using the scale 1 to 5,
1=poor, 5=excellent or N/A=not applicable:

	1-Poor	2	3-Neutral	4	5-Excellent	N/A
Being responsive to your requests	Being responsive to your requests 1-Poor	Being responsive to your requests 2	Being responsive to your requests 3-Neutral	Being responsive to your requests 4	Being responsive to your requests 5-Excellent	Being responsive to your requests N/A
Responding to your inquiries in a timely manner	Responding to your inquiries in a timely manner 1-Poor	Responding to your inquiries in a timely manner 2	Responding to your inquiries in a timely manner 3-Neutral	Responding to your inquiries in a timely manner 4	Responding to your inquiries in a timely manner 5-Excellent	Responding to your inquiries in a timely manner N/A
Courteousness of the person you engaged with	Courteousness of the person you engaged with 1-Poor	Courteousness of the person you engaged with 2	Courteousness of the person you engaged with 3-Neutral	Courteousness of the person you engaged with 4	Courteousness of the person you engaged with 5-Excellent	Courteousness of the person you engaged with N/A
How informative the person you engaged with was	How informative the person you engaged with was 1-Poor	How informative the person you engaged with was 2	How informative the person you engaged with was 3-Neutral	How informative the person you engaged with was 4	How informative the person you engaged with was 5-Excellent	How informative the person you engaged with was N/A
The ability of the person you engaged with to provide you with the information you requested	The ability of the person you engaged with to provide you with the information you requested 1-Poor	The ability of the person you engaged with to provide you with the information you requested 2	The ability of the person you engaged with to provide you with the information you requested 3-Neutral	The ability of the person you engaged with to provide you with the information you requested 4	The ability of the person you engaged with to provide you with the information you requested 5-Excellent	The ability of the person you engaged with to provide you with the information you requested N/A
The ability of the person you engaged with to answer your question to your satisfaction	The ability of the person you engaged with to answer your question to your satisfaction 1-Poor	The ability of the person you engaged with to answer your question to your satisfaction 2	The ability of the person you engaged with to answer your question to your satisfaction 3-Neutral	The ability of the person you engaged with to answer your question to your satisfaction 4	The ability of the person you engaged with to answer your question to your satisfaction 5-Excellent	The ability of the person you engaged with to answer your question to your satisfaction N/A
How would you rank the work the CW Network is doing?	How would you rank the work the CW Network is doing? 1-Poor	How would you rank the work the CW Network is doing? 2	How would you rank the work the CW Network is doing? 3-Neutral	How would you rank the work the CW Network is doing? 4	How would you rank the work the CW Network is doing? 5-Excellent	How would you rank the work the CW Network is doing? N/A

Any other comments regarding the above questions.

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* 1. How did your hear about the Network of Specialized Care?

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* 2. What are the most common reasons you contact the CW Network office? (check all that apply)

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* 3. If applicable, please check off which sector you work in:

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* 4. What region do you or your organization operate in? (check all that apply)

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* 5. If applicable, please check off which position you hold in your organization:

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* 6. How would you rank the CW Network on the following questions, using the scale 1 to 5,1=poor, 5=excellent or N/A=not applicable:

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* 7. Is there a positive story about the Network or any other thoughts or comments you'd like to share?

* 6. How would you rank the CW Network on the following questions, using the scale 1 to 5,
1=poor, 5=excellent or N/A=not applicable: