Your honest opinion will help us make our programs and services better. Please answer all the questions. Your answers will be kept private. Comments you make in this survey may be used in a summary report but will be kept anonymous. Questions? Please call: Kate Dymock, Primary Health Services Director or Andy Kroeker, Executive Director at 519-768-1715

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* 1. Please rate the following aspects of your experience:

  Never  Some of the time Most of the time Always
The Health Centre space is free from barriers and I can do what I need to when I'm there
Services are offered in a way that meets my needs (language, culture, safety, etc.)
Staff speak using plain language that is easy to understand and avoid confusing words.
I trust the Health Centre staff to keep information about me private.
I am confident that staff has the knowledge, time and resources to help me.
Staff helps me get the services I need at the Health Centre and in the community.
Using Health Centre services has improved my health and well-being.
I receive services when I need them.
There are enough opportunities to give feedback or suggestions.
I would recommend the Health Centre services and programs to my friends and family.
I am satisfied with the services and programs I receive through the Health Centre
I feel comfortable and welcome at the Health Centre.

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* 2. Thinking of your overall experience with our Health Centre programs and services what are two things done very well?

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* 3. Thinking of your overall experience with our Health Centre programs and services what are two things that can be improved?

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* 4. Is there any additional information or feedback you would like to share with us that could help us improve the way we provide care or services?

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* 5. Please answer Questions 5-7 if you have a Doctor or Nurse Practitioner here. (Everyone else skip to Question 8)
The last time you were sick or were concerned you had a health problem did you get an appointment on the day you wanted?

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* 6. Please answer Questions 5-7 if you have a Doctor or Nurse Practitioner here. (Everyone else skip to Question 8)
How Many days did it take from when you first tried to see your doctor or nurse practitioner to when you actually SAW him/her or someone else in the Health Centre?

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* 7. Please answer Questions 5-7 if you have a Doctor or Nurse Practitioner here. (Everyone else skip to Question 8)
When you see your Doctor or Nurse Practitioner, how often do they or someone else in the Health Centre:

  Never  Rarely Sometimes Often Always
give you an opportunity to ask questions about recommended treatment?
involve you as much as you want to be in decisions about your care and treatment?
spend enough time with you?

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* 8. 'A sense of belonging is the feeling of being connected and accepted within one's community'
Would you describe your sense of belonging to your community as:

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* 9. In general, would you say your overall physical health is:

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* 10. In general, would you say your overall mental health is:

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* 11. How long have you been a client at the Health Centre

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* 12. How would you describe your gender

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* 13. How old are you?

T