We would like to hear about your overall stroke experience.  To complete this questionnaire, please think about how you felt during your overall stroke journey.  We will only use this information to improve the care and services provided to persons with stroke and their families/caregivers. This questionnaire is voluntary and anonymous.
 
All pictographs were reproduced with permission from the Aphasia Institute.

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* 1. I am a (check all that apply):

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* 2. Please enter today's date:

Date

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* 3. When was the stroke?

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* 4. Which program or service passed you the questionnaire?

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* 5. How could your stroke experience have been improved?

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Next question is about your interaction with staff:

Next question is about your interaction with staff:

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* 6. How was your interaction with staff during care?  I felt... (check all that apply)

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Next question is about how things were communicated to you:

Next question is about how things were communicated to you:

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* 7. How were things communicated to you? I felt... (check all that apply)

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Next question is about feeling prepared about what happens next:

Next question is about feeling prepared about what happens next:

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* 8. Did you feel you were prepared for what was going to happen next? I felt... (check all that apply)

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Next question is about the information and/or resources provided:

Next question is about the information and/or resources provided:

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* 9. How did you feel about the information and/or resources provided? I felt... (check all that apply)

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Next question is about adjusting to life after stroke:

Next question is about adjusting to life after stroke:

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* 10. How did you feel about adjusting to life after stroke? I felt... (check all that apply)

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Next question is about other experiences that stand out:

Next question is about other experiences that stand out:

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* 11. Tell us how you felt about other experiences in your stroke journey that stand out? I felt... (check all that apply)

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