Mental Health Outpatient Clinic Patient and Family Experience Survey
1.
Who is completing this survey
Patient/Client
Family Member/Caregiver
2.
Your experience was at which Community Mental Health Clinic?
Goderich
Clinton
Exeter
Seaforth
Wingham
3.
In the last 12 months, how many times (including this one) have you visited this outpatient clinic for any condition?
This was the only time
2 or 3 times
4 to 8 times
More than 8 times
4.
Did the hospital change your appointment to a later date?
No
Yes, once
Yes, 2 or 3 times
Yes, 4 times or more
5.
Before your appointment, did you know what would happen to you during the appointment?
Definitely
For the most part
Somewhat
Not at all
Don't know/Can't remember
6.
If your appointment did not start on time, how many minutes did you have to wait in the waiting room?
1 was seen on time, or early
I waited up to 15 minutes
I waited up to 60 minutes
I waited more than 60 minutes
Don't know/Can/t remember
7.
If you had to wait, were you told why?
Yes
No, but I would have liked a reason
No, but I did not mind
Don't know/Can't remember
I did not have to wait
8.
Did the health professionals treating and examining you introduce themselves?
Yes, all of the staff introduced themselves
Some of the staff introduced themselves
Very few or none of the staff introduced themselves
Don't know/Can't remember
9.
How much information about your condition or treatment was given to your family, caregiver or someone close to you?
Not enough
Right amount
Too much
No family, caregiver or friends were involved
They didn't want or need information
I didn't want them to have any information
Don't know/Can't say
10.
Were you given enough privacy when discussing your condition or treatment?
Definitely
For the most part
Somewhat
Not at all (
please tell us more in the open text box at the end of this survey)
11.
How often, during your most recent visit, were you
involved as much as you wanted to be
in decisions about your care and treatment?
Always
Usually
Sometimes
Never
12.
Before you left the outpatient area were you told what would happen next (for example, did you need another appointment, did you need to see you family doctor)?
Definitely
For the most part
Somewhat
Not at all
Don't know/can't remember
13.
Did you receive enough information from hospital staff about what to do if you were worried about your condition or treatment after you left the clinic?
Not at all
Partly
Quite a bit
Completely
14.
Overall, did you feel you were treated with respect and dignity while you were at the clinic?
Definitely
For the most part
Somewhat
Not at all
15.
Overall...(Please pick a number)
0 I had a very poor experience
1
2
3
4
5
6
7
8
9
10 I had a very good experience
16.
Thinking about your experience related to this visit, to what extent did you experience smooth transitions between the outpatient area and other locations or health professionals?
Always
Usually
Sometimes
Never
Not applicable
17.
What else would you like to say about this outpatient experience?
(Please do not include any names, contact information, or identifying information)
If you have any immediate questions or concerns regarding your experience with us, please contact our Patient Relations Office using the contact information below.
