We would love to hear from you! Survey

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* 1. Do you have a family doctor?

Yes

No - IF NO, SKIP TO QUESTION 3

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* 2. If you have a family doctor, how easy is it to get in to see him/her when you want to?

Easy

Somewhat easy

Neither easy nor difficult

Somewhat difficult

Difficult

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* 3. If you do not have a family doctor, how important is it to get one?

Extremely important

Very important

Somewhat important

Not so important

Not at all important

Not applicable, I have a doctor

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* 4. Do you need care from people other than a family doctor? (For example help with mental health counselling, foot care, physiotherapy, finding health promotion programs in your neighbourhood etc.)

I don't know

Yes

If YES could you please specify

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* 5. Have you had to see a specialist physician for any health related challenge?

Yes

No - IF NO SKIP TO QUESTION 7

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* 6. If you have seen a specialist physician, how easy was it to:

	Easy	Neither easy nor difficult	Difficult
Get an appointment	Get an appointment Easy	Get an appointment Neither easy nor difficult	Get an appointment Difficult
Receive information about the appointment	Receive information about the appointment Easy	Receive information about the appointment Neither easy nor difficult	Receive information about the appointment Difficult
Find the location of the appointment	Find the location of the appointment Easy	Find the location of the appointment Neither easy nor difficult	Find the location of the appointment Difficult
Receive follow-up information about your care after your appointment	Receive follow-up information about your care after your appointment Easy	Receive follow-up information about your care after your appointment Neither easy nor difficult	Receive follow-up information about your care after your appointment Difficult

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* 7. Would you join a health promotion program that could help you feel better? For example, a group program that helps you learn about eating well if you have Diabetes, or a program that might teach you how to be mindful if you are feeling stressed.

Yes

I don't know

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* 8. Would you, or someone in your family, benefit from home care or home support services? (For example a Personal Support Worker, Meals on Wheels, Friendly Visiting)

Yes

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* 9. Would you, or someone in your family, benefit from mental health and/or addictions support? (For example, therapy & counselling, assistance with addictions, early childhood development assessment, supportive housing)

Yes

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* 10. In general, how would you rate your physical and mental health and well-being?

Excellent

Very Good

Good

Fair

Poor

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* 11. In general, how do you feel?

I feel great!

I feel good

I feel just ok

I feel unwell

I feel terrible

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* 12. What is your age?

16 - 24

25 - 34

35 - 49

50 - 64

65 - 74

75+

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* 13. With which gender do you identify?

Female

Male

Other (please specify)

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* 1. Do you have a family doctor?

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* 2. If you have a family doctor, how easy is it to get in to see him/her when you want to?

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* 3. If you do not have a family doctor, how important is it to get one?

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* 4. Do you need care from people other than a family doctor? (For example help with mental health counselling, foot care, physiotherapy, finding health promotion programs in your neighbourhood etc.)

Question Title

* 5. Have you had to see a specialist physician for any health related challenge?

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* 6. If you have seen a specialist physician, how easy was it to:

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* 7. Would you join a health promotion program that could help you feel better? For example, a group program that helps you learn about eating well if you have Diabetes, or a program that might teach you how to be mindful if you are feeling stressed.

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* 8. Would you, or someone in your family, benefit from home care or home support services? (For example a Personal Support Worker, Meals on Wheels, Friendly Visiting)

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* 9. Would you, or someone in your family, benefit from mental health and/or addictions support? (For example, therapy & counselling, assistance with addictions, early childhood development assessment, supportive housing)

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* 10. In general, how would you rate your physical and mental health and well-being?

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* 11. In general, how do you feel?

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* 12. What is your age?

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* 13. With which gender do you identify?

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* 14. What language do you speak at home?