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HOSPITAL SURVEY

Chatham-Kent Health Coalition & Wallaceburg-Walpole Island First Nation Health Coalition

The purpose of this survey is to identify our community's needs regarding hospital care. We will use the information in meetings with the hospital CEO, the government-appointed hospital Supervisor and the Minister of Health and his staff. Our goal is to advocate for the health care services our community needs. 

Please note: You do not have to provide any identifying information at all. If you do give us your name and contact information, we will not use identifying information unless you expressly give us permission to do so. You will see there is checkbox for this at the end of the survey. 

If for any of the questions you have multiple experiences, you can put in one or more of them. 
1.Have you or a family member (spouse, parent, child, grandparent, sibling) needed hospital care in the last three years? If NO, please skip to question 9.
2.What hospital service did you or your family member require? (eg. emergency department, cancer care, surgeries, diagnostic testing).
3.Were you able to access this service in Chatham?
4.Were you able to access this service in Wallaceburg? 
5.If NO, where did you travel to in order to get the service? (For example: London, Sarnia, Windsor)
6.Did you have a long wait to access this service?
7.If Yes, how long did you wait? Please provide any details you wish to provide.
8.In the last three years have you or a direct family member had difficulty traveling to access needed hospital care in a different town or city?
9.If YES, please provide any details you wish to provide.
10.In the last three years have you or your family member experienced any gaps in hospital service? (For example: problems accessing care, long waits for care or going without needed care)
11.If YES, please explain.
12.Have you or your family member had a good or positive experience accessing hospital care within the last three years?
13.If YES, which hospital did you go to? Please describe your experience.
14.If more hospital services in Wallaceburg were to be closed down and the patients from Wallaceburg, Walpole Island and the surrounding counties were required to access care at the Chatham hospital, do you think that your access to hospital care will improve, worsen or stay the same, and why? Please also share any comments or thoughts about the cuts to services that have occurred in Wallaceburg and Chatham hospitals.
15.Please write any key points you would like us to relay to the hospital CEO, the government-appointed Supervisor of the Chatham Kent Health Alliance, and/or the Minister of Health and his staff.
16.***********PLEASE NOTE THIS INFORMATION IS OPTIONAL************
17.Would you be willing to speak publicly (example: to the media) about the experiences you have described here?
18.Would you like the local Health Coalition to keep in touch with you, sending you updates and information about events?