Client Satisfaction Survey

You are being invited to take part in this survey because you have recently had a visit with us.

Your responses to the questions on this survey will help us improve the care and programs we provide. Participation in this survey is completely voluntary and all your responses to the survey questions will be kept confidential.

1.First & Last Name (Optional)

2.Phone Number (Optional)

3.Email (Optional)

4.Address (Optional)

*5.Please identify the community/clinic you attended(Required.)

Atikameksheng Anishnawbek

Sagamok Anishnawbek

Serpent River First Nation

Mississauga First Nation

Thessalon First Nation

Garden River First Nation

Batchewana First Nation

SSM Indigenous Friendship Centre

Baawaating Family Health Team

3 Maple Street Clinic in Wawa

Chapleau Cree First Nation

Brunswick House First Nation

Michipicoten First Nation

*6.Feedback: Compliments/Concerns:(Required.)

*7.Who did you see today?(Required.)

Nurse Practitioner

Doctor

Mental Wellness Worker

Dietitian

Diabetes Nurse Educator

Minobimaadizing Program

Traditional Healer

Physiotherapist

Occupational Therapist

Rehab Assistant (OTA/PTA)

Other (please specify)

8.The last day you were sick or concerned you had a health problem; did you get an appointment on the date that you wanted?

Yes

9.Did you request a same day/next day appointment?

Yes

No (if no, skip to question 10)

10.If you requested a same day/next day appointment, did you receive one?

Yes

*11.I feel comfortable and welcome at the centre/office.(Required.)

Always

Often

Sometimes

Rarely

Never

If rarely or never, please tell us why

*12.When you see your doctor or nurse practitioner, how often do they or someone else in the office involve you as much as you want to be in the decisions about your care and treatment?(Required.)