Stakeholder Input-Building Needs Survey

Question Title

* 1. How often do you come to GIHN?

More than once a week

Once a week

Once a month

More than once a month but not once a week

Once a quarter/3 months

More than once every 3 months but not monthly

Question Title

* 2. How important do you feel the following are to you as a GIHN consumer/guest? 1 being least important and 5 being most important.

	1	2	3	4	5
Digital check-in	Digital check-in 1	Digital check-in 2	Digital check-in 3	Digital check-in 4	Digital check-in 5
Private registration area	Private registration area 1	Private registration area 2	Private registration area 3	Private registration area 4	Private registration area 5
Separate check-in and check-out windows	Separate check-in and check-out windows 1	Separate check-in and check-out windows 2	Separate check-in and check-out windows 3	Separate check-in and check-out windows 4	Separate check-in and check-out windows 5
Children’s activity/waiting area	Children’s activity/waiting area 1	Children’s activity/waiting area 2	Children’s activity/waiting area 3	Children’s activity/waiting area 4	Children’s activity/waiting area 5
Vending machines for snacks and drinks	Vending machines for snacks and drinks 1	Vending machines for snacks and drinks 2	Vending machines for snacks and drinks 3	Vending machines for snacks and drinks 4	Vending machines for snacks and drinks 5
Family restroom(s)	Family restroom(s) 1	Family restroom(s) 2	Family restroom(s) 3	Family restroom(s) 4	Family restroom(s) 5
Gender neutral restroom(s)	Gender neutral restroom(s) 1	Gender neutral restroom(s) 2	Gender neutral restroom(s) 3	Gender neutral restroom(s) 4	Gender neutral restroom(s) 5
Private pharmacy treatment/consultation area	Private pharmacy treatment/consultation area 1	Private pharmacy treatment/consultation area 2	Private pharmacy treatment/consultation area 3	Private pharmacy treatment/consultation area 4	Private pharmacy treatment/consultation area 5
Child-friendly meeting rooms	Child-friendly meeting rooms 1	Child-friendly meeting rooms 2	Child-friendly meeting rooms 3	Child-friendly meeting rooms 4	Child-friendly meeting rooms 5
Outside bus stop shelter	Outside bus stop shelter 1	Outside bus stop shelter 2	Outside bus stop shelter 3	Outside bus stop shelter 4	Outside bus stop shelter 5

Question Title

* 3. Are there office space features you feel would be beneficial to your GIHN Treatment experience that you would like to suggest?

Question Title

* 4. What is your relationship to GIHN?

Consumer

Family member of a consumer

Community Partner

Community member