Mental Health Outpatient Clinic Patient and Family Experience Survey

Question Title

* 1. Who is completing this survey

Patient/Client

Family Member/Caregiver

Question Title

* 2. Your experience was at which Community Mental Health Clinic?

Goderich

Clinton

Exeter

Seaforth

Wingham

Question Title

* 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

Question Title

* 4. Did the hospital change your appointment to a later date?

Yes, once

Yes, 2 or 3 times

Yes, 4 times or more

Question Title

* 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

Question Title

* 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

Question Title

* 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

Question Title

* 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

Question Title

* 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

Question Title

* 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)

Question Title

* 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

Question Title

* 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

Question Title

* 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

Question Title

* 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

Question Title

* 15. Overall...(Please pick a number)

0 I had a very poor experience

10 I had a very good experience

Question Title

* 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

Question Title

* 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.