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* 1. Please tell us who is completing the survey:

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* 2. Did staff introduce themselves to you before providing care?

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* 3. Did you feel that you were treated with respect and dignity during your visit to the Mental Health and Addictions Program?

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* 4. Were you or your caregiver asked what your NEEDS or CULTURAL values are when making decisions about your care?
(Your unique needs, customs, beliefs, rituals, traditions, such as any or all of the following: accessibility needs; dietary restrictions such as gluten-free, vegetarian, etc.; interpreter assistance for all languages; family members or close friends present; visits by clergy members, elders, or spiritual leaders; visits to the multi-denominational chapel; access to the traditional ceremonial room; traditional healing options; sacraments or sacred rituals; who you would like to make decisions about your care if not you, etc.)

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* 5. Did you receive enough information from MHAP staff about what to do if you were worried about your mental health/addictions needs after you were finished receiving care at MHAP?

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* 6. In general, how confident are you that you know what to do to take care of and manage your substance use and/or mental health?

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* 7. Did staff address your anxiety and fears in a way that you felt cared for?

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* 8. Do you feel that coming to the Mental Health and Addictions Program helped you?

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* 9. What topics did you find helpful during your visit?

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* 10. Would you recommend the Mental Health and Addictions Program at SLMHC to family and friends?

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* 11. Please rate Sioux Lookout Meno Ya Win Health Centre with a number from 1 - 10, with 10 being the best health centre possible and 1 being the worst health centre possible. 

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* 12. Is there anyone you would like to recognize for the care he or she provided?

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* 13. Are there any general comments or feedback for improvement you would like to share?

If you would like to provide additional feedback, please ask any staff member for a Compliment/Feedback Form.

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