Gizhewaadiziwin Health Access Centre

GHAC Client Experience Survey

You are being invited to take part in this survey because you have recently had a visit at the Gizhewaadiziwin Health Access Centre.
Your responses to the questions on this survey will help us improve the care we provide.
There are six sections of the survey and it will take approximately 5 minutes to complete.
Participation in the survey is completely voluntary and all your responses
to the survey questions will be kept confidential.

Question Title

* 1. Are you completing the survey for yourself or for another person?

I am completing this survey for myself

I am completing this survey for another person

Question Title

* 2. If you are completing this survey for someone else, who are you completing it for?

I am completing this for a family member or friend

I am completing this for a patient or client

Other (please specify your relationship with the patient, not your name)

SECTION 1: CONTACTING US

Question Title

* 3. How was the appointment for your most recent visit made?

I didn't have an appointment -- I just dropped in

I called and set it up

I set it up at my last visit

You called me to set it up

Other (please specify)

Question Title

* 4. Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the following

	Poor	Fair	Good	Very Good	Excellent
a. The length of time it took between making your appointment and the visit you just had	a. The length of time it took between making your appointment and the visit you just had Poor	a. The length of time it took between making your appointment and the visit you just had Fair	a. The length of time it took between making your appointment and the visit you just had Good	a. The length of time it took between making your appointment and the visit you just had Very Good	a. The length of time it took between making your appointment and the visit you just had Excellent
b. Your *overall* experience accessing the centre	b. Your *overall* experience accessing the centre Poor	b. Your *overall* experience accessing the centre Fair	b. Your *overall* experience accessing the centre Good	b. Your *overall* experience accessing the centre Very Good	b. Your *overall* experience accessing the centre Excellent