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Midwifery Services May. 1, 2025 - Dec. 31, 2025

Client Experience Questionnaire

Tell us about your experience!  Your feedback helps us to improve the way we provide care.  This questionnaire was built upon our Patient Values (Dignity, Respect and Trust, Information Sharing, Participation, Accessibility and Responsiveness and Quality).

We do not collect personal information unless you request a follow-up.

If the question does not apply, please leave blank.
Dignity, Respect and Trust:
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
a.  I was treated with respect.
b.  My privacy was respected as best it could be.
c.  My cultural needs were considered. (e.g. individuals’ own beliefs, customs, social standards, traditions or religious beliefs)
d. Before providing care, staff members introduced themselves to me, where appropriate.
e. In general, staff were compassionate.
Information Sharing:
(If question does not apply, leave blank)
Always
Usually
Sometimes
Never
a.  Staff talked to me about what medications I am taking at home.  (e.g. prescription, supplements, herbal, etc.)
b.  Staff talked to me about my health care options.  (e.g. procedures/tests)
c.  My health care provider used words I could understand.
d.  I had the necessary information needed to make good decisions about my health.
e.  The staff kept my information confidential and secure.
Participation:
(If question does not apply, leave blank)
Always
Usually
Sometimes
Never
a.  Staff involved me or my family/support system in making decisions about my care.
b.  I was encouraged to take part in my care as much as I was able.
c.  My choices were respected.
d.  I was comfortable expressing concerns about my care.
Accessibility and Responsiveness:
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
a.  My care was well coordinated.
b.  I was cared for in a timely manner.
c.  I had access to the care I needed.
d.  My concerns were taken seriously.
e.  I am aware of the Prairie Mountain Health (PMH) services and programs available to get the support I need for my health care journey.
Quality:
(If question does not apply, leave blank)
Always
Usually
Sometimes
Never
a.  I saw the health care provider(s) clean their hands before providing my care.
b.  My identity was confirmed before receiving care.  (e.g. asked my name, checked my wrist band, asked my date of birth)
Quality:
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
c. My healthcare provider discussed risks or hazards that could cause falls/slips/trips (e.g. proper footwear, wet floors, icy sidewalks, uneven surfaces, etc.).
d.  I felt staff were up to date on the skills needed to provide my care.
e.  Overall, I was satisfied with the quality of care I received.
Midwifery Program Specific Questions-
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
a. There was good communication between the midwife and other health care providers involved in my care. 
I received appropriate information needed to make informed choices for my: 
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
i. Pregnancy
ii. Labour
iii. Postpartum care
Midwifery Program Specific Questions-
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
c. My midwife explained all clinical procedures before they were provided.
d. I felt my midwife understood my health concerns related to my pregnancy.
e. I was aware of what to do if I had concerns.
f. I felt involved in decision making throughout my labor.
g. I was supported in making decisions about how I gave birth.
h. I felt supported after the birth of my baby.
Is there anything we can do differently to improve your experience?
What was the best part about your care?
Demographics:  (of the patient) Collected for statistical purposes only to target improvements.
Who completed survey?
Ethnicity
Age:
Comments:
Forward additional concerns or compliments regarding your care to Patient Relations.
Patient Relations: email patientrelations@pmh-mb.ca or call 1-800-735-6596

Midwifery Patient Partner Volunteers Needed!! Someone just like you helped to design this survey!
We want to partner with existing Midwifery patients or family members who might be interested in helping us review, design or provide feedback to our services.

If you would like more information or if you think you might be interested in becoming a Patient Partner, please click on the link below or contact Patient Relations by calling 1-800-735-6596.

https://prairiemountainhealth.ca/forms/patient-partner/
Questions or concerns related to this survey can be sent to ceq@pmh-mb.ca

Thank you for your participation!