Diagnostic Imaging Department Patient Experience Survey

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* 1. What is your patient status?

Inpatient

Outpatient

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* 2. What type of examination/procedure did you have done today?

General X-ray

X-ray Procedure (barium)

Ultrasound

Mammography

Pain Therapy Clinic

Mammography Biopsy Clinic

Other (please specify)

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* 3. If you are a woman of child-bearing age (11 - 55 years) having an X-ray, CT, or Mammography, did the staff ask you if there was any possibility that you might be pregnant?

Yes

N/A

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* 4. Did the staff introduce themselves to you?

Never

Sometimes

Usually

Always

Already knew him/her

Don't Know/Not Applicable

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* 5. Did the staff explain their role before they offered care?

Never

Sometimes

Usually

Always

Don't Know/Not Applicable

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* 6. Did the staff consider my cultural values before/during providing care

Never

Sometimes

Usually

Always

Don't Know/Not Applicable

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* 7. Overall, how would you rate the following?

	Very Poor	Poor	Fair	Very Good	Excellent
The care you received in the Diagnostic Imaging Department	The care you received in the Diagnostic Imaging Department Very Poor	The care you received in the Diagnostic Imaging Department Poor	The care you received in the Diagnostic Imaging Department Fair	The care you received in the Diagnostic Imaging Department Very Good	The care you received in the Diagnostic Imaging Department Excellent
How well the staff explained the procedure to you.	How well the staff explained the procedure to you. Very Poor	How well the staff explained the procedure to you. Poor	How well the staff explained the procedure to you. Fair	How well the staff explained the procedure to you. Very Good	How well the staff explained the procedure to you. Excellent
The time the procedure took to be completed.	The time the procedure took to be completed. Very Poor	The time the procedure took to be completed. Poor	The time the procedure took to be completed. Fair	The time the procedure took to be completed. Very Good	The time the procedure took to be completed. Excellent
Staff's response to your questions or concerns.	Staff's response to your questions or concerns. Very Poor	Staff's response to your questions or concerns. Poor	Staff's response to your questions or concerns. Fair	Staff's response to your questions or concerns. Very Good	Staff's response to your questions or concerns. Excellent
How respectful and professional the staff was.	How respectful and professional the staff was. Very Poor	How respectful and professional the staff was. Poor	How respectful and professional the staff was. Fair	How respectful and professional the staff was. Very Good	How respectful and professional the staff was. Excellent
How sensitive the staff was.	How sensitive the staff was. Very Poor	How sensitive the staff was. Poor	How sensitive the staff was. Fair	How sensitive the staff was. Very Good	How sensitive the staff was. Excellent
The customer service from the staff.	The customer service from the staff. Very Poor	The customer service from the staff. Poor	The customer service from the staff. Fair	The customer service from the staff. Very Good	The customer service from the staff. Excellent
How well my privacy was respected.	How well my privacy was respected. Very Poor	How well my privacy was respected. Poor	How well my privacy was respected. Fair	How well my privacy was respected. Very Good	How well my privacy was respected. Excellent
How confidential the staff was.	How confidential the staff was. Very Poor	How confidential the staff was. Poor	How confidential the staff was. Fair	How confidential the staff was. Very Good	How confidential the staff was. Excellent

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* 8. How would you rate your overall care at the Diagnostic Imaging Department?

Very Poor

Poor

Fair

Very Good

Excellent

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* 9. Would you recommend the Diagnostic Imaging Department of the Sioux Lookout Meno Ya Win Health Centre to friends and family?

Unsure

Definitely No

Probably No

Probably Yes

Definitely Yes

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* 10. Please rate the Sioux Lookout Meno Ya Win Health Centre using any number from 1 - 10, where 1 is the WORST health centre possible and 10 is the BEST health centre possible

1 - Worst

10 - Best

1 - Worst

10 - Best

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* 11. Do you have any comments?

Thank you for taking the time to complete this survey. We value your opinion and we appreciate your feedback to maintain a high quality of service for our community by identifying opportunities for improvement.