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Community Feedback on the Central West Network of Specialized Care
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1.
How did your hear about the Network of Specialized Care?
(Required.)
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2.
What are the most common reasons you contact the CW Network office? (check all that apply)
(Required.)
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)
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)
(Required.)
Dufferin
Halton
Peel
Waterloo
Wellington
If other, please specify below:
Other:
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:
(Required.)
1-Poor
2
3-Neutral
4
5-Excellent
N/A
Being responsive to your requests
1-Poor
2
3-Neutral
4
5-Excellent
N/A
Responding to your inquiries in a timely manner
1-Poor
2
3-Neutral
4
5-Excellent
N/A
Courteousness of the person you engaged with
1-Poor
2
3-Neutral
4
5-Excellent
N/A
How informative the person you engaged with was
1-Poor
2
3-Neutral
4
5-Excellent
N/A
The ability of the person you engaged with to provide you with the information you requested
1-Poor
2
3-Neutral
4
5-Excellent
N/A
The ability of the person you engaged with to answer your question to your satisfaction
1-Poor
2
3-Neutral
4
5-Excellent
N/A
How would you rank the work the CW Network is doing?
1-Poor
2
3-Neutral
4
5-Excellent
N/A
Any other comments regarding the above questions.
7.
Is there a positive story about the Network or any other thoughts or comments you'd like to share?
