Diabetes Wellness Survey

Client Experience Survey 2023

You are being invited to take part in this survey because you have recently had a visit at Windsor Essex Community Health Centre (weCHC), Diabetes Wellness.

Your responses to the questions on this survey will help us improve the care we provide. It will take approximately 5-10 minutes to complete.

Participation in the survey is completely voluntary and all your responses to the survey questions will be kept confidential.

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* 1. Are you completing this survey for yourself or for another person?

I am completing this survey for myself

I am completing this survey for another person

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* 2. If you are completing this survey for someone else, who are you completing it for?

I am completing this for a family member or friend

I am completing this for the patient/client

Other (please specify your relationship with the patient, not your name)

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* 3. Location / Program where you receive services:

Diabetes Wellness

Other

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* 4. Section 1: Contacting Us
How was the appointment for your most recent visit made?

I didn't have an appointment - I just dropped in

I called and set it up

I emailed and set it up

I set it up at my last visit

You called me to set it up

Other (please specify)

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* 5. Section 1: Contacting Us
Thinking about your most recent visit, on a scale
of poor to excellent, how would you rate the following …

	Poor	Fair	Good	Very Good	Excellent
The length of time it took between making your appointment and the visit you just had	The length of time it took between making your appointment and the visit you just had Poor	The length of time it took between making your appointment and the visit you just had Fair	The length of time it took between making your appointment and the visit you just had Good	The length of time it took between making your appointment and the visit you just had Very Good	The length of time it took between making your appointment and the visit you just had Excellent
Your overall experience accessing the centre	Your overall experience accessing the centre Poor	Your overall experience accessing the centre Fair	Your overall experience accessing the centre Good	Your overall experience accessing the centre Very Good	Your overall experience accessing the centre Excellent

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* 6. Section 2: Arriving and Waiting at the Centre
On a scale of poor to excellent, how would you rate the following:

	Poor	Fair	Good	Very Good	Excellent	Not Applicable (N/A)
The length of time you had to wait in the reception/ waiting area	The length of time you had to wait in the reception/ waiting area Poor	The length of time you had to wait in the reception/ waiting area Fair	The length of time you had to wait in the reception/ waiting area Good	The length of time you had to wait in the reception/ waiting area Very Good	The length of time you had to wait in the reception/ waiting area Excellent	The length of time you had to wait in the reception/ waiting area Not Applicable (N/A)
Your overall experience with our reception staff	Your overall experience with our reception staff Poor	Your overall experience with our reception staff Fair	Your overall experience with our reception staff Good	Your overall experience with our reception staff Very Good	Your overall experience with our reception staff Excellent	Your overall experience with our reception staff Not Applicable (N/A)

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* 7. Section 3: Your Appointment
Thinking about the MAIN health care provider you spoke with during a visit, on a scale of poor to excellent, how would you rate this person on the following:

	Poor	Fair	Good	Very Good	Excellent
They knew about your medical history	They knew about your medical history Poor	They knew about your medical history Fair	They knew about your medical history Good	They knew about your medical history Very Good	They knew about your medical history Excellent
They listened to your concerns	They listened to your concerns Poor	They listened to your concerns Fair	They listened to your concerns Good	They listened to your concerns Very Good	They listened to your concerns Excellent
They met my needs and expectations in this appointment	They met my needs and expectations in this appointment Poor	They met my needs and expectations in this appointment Fair	They met my needs and expectations in this appointment Good	They met my needs and expectations in this appointment Very Good	They met my needs and expectations in this appointment Excellent
They explained things in a way that was easy to understand	They explained things in a way that was easy to understand Poor	They explained things in a way that was easy to understand Fair	They explained things in a way that was easy to understand Good	They explained things in a way that was easy to understand Very Good	They explained things in a way that was easy to understand Excellent
They were sensitive to your needs and preferences	They were sensitive to your needs and preferences Poor	They were sensitive to your needs and preferences Fair	They were sensitive to your needs and preferences Good	They were sensitive to your needs and preferences Very Good	They were sensitive to your needs and preferences Excellent
They treated you with dignity and respect	They treated you with dignity and respect Poor	They treated you with dignity and respect Fair	They treated you with dignity and respect Good	They treated you with dignity and respect Very Good	They treated you with dignity and respect Excellent
They gave you clear instructions about what you need to do after your visit	They gave you clear instructions about what you need to do after your visit Poor	They gave you clear instructions about what you need to do after your visit Fair	They gave you clear instructions about what you need to do after your visit Good	They gave you clear instructions about what you need to do after your visit Very Good	They gave you clear instructions about what you need to do after your visit Excellent
Your overall experience speaking with the health care provider about the reason for your visit	Your overall experience speaking with the health care provider about the reason for your visit Poor	Your overall experience speaking with the health care provider about the reason for your visit Fair	Your overall experience speaking with the health care provider about the reason for your visit Good	Your overall experience speaking with the health care provider about the reason for your visit Very Good	Your overall experience speaking with the health care provider about the reason for your visit Excellent

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* 8. I feel comfortable and welcomed at weCHC.

Yes

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* 9. Have you spoken to your educator recently about your retinopathy screening?

Yes

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* 10. Have you spoken to you educator recently about foot health?

Yes

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* 11. Section 4: Your Overall Experience With Your Most Recent Visit
Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the following:

	Poor	Fair	Good	Very Good	Excellent	Not applicable (don’t know or do not wish to answer)
The overall cleanliness of the centre	The overall cleanliness of the centre Poor	The overall cleanliness of the centre Fair	The overall cleanliness of the centre Good	The overall cleanliness of the centre Very Good	The overall cleanliness of the centre Excellent	The overall cleanliness of the centre Not applicable (don’t know or do not wish to answer)
The overall physical comfort of the centre	The overall physical comfort of the centre Poor	The overall physical comfort of the centre Fair	The overall physical comfort of the centre Good	The overall physical comfort of the centre Very Good	The overall physical comfort of the centre Excellent	The overall physical comfort of the centre Not applicable (don’t know or do not wish to answer)
Your confidence in the health care provider(s) you saw during the visit	Your confidence in the health care provider(s) you saw during the visit Poor	Your confidence in the health care provider(s) you saw during the visit Fair	Your confidence in the health care provider(s) you saw during the visit Good	Your confidence in the health care provider(s) you saw during the visit Very Good	Your confidence in the health care provider(s) you saw during the visit Excellent	Your confidence in the health care provider(s) you saw during the visit Not applicable (don’t know or do not wish to answer)
Your confidence that your health information was treated with the level of privacy you expect	Your confidence that your health information was treated with the level of privacy you expect Poor	Your confidence that your health information was treated with the level of privacy you expect Fair	Your confidence that your health information was treated with the level of privacy you expect Good	Your confidence that your health information was treated with the level of privacy you expect Very Good	Your confidence that your health information was treated with the level of privacy you expect Excellent	Your confidence that your health information was treated with the level of privacy you expect Not applicable (don’t know or do not wish to answer)
Your overall experience with the visit you had with us	Your overall experience with the visit you had with us Poor	Your overall experience with the visit you had with us Fair	Your overall experience with the visit you had with us Good	Your overall experience with the visit you had with us Very Good	Your overall experience with the visit you had with us Excellent	Your overall experience with the visit you had with us Not applicable (don’t know or do not wish to answer)

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* 12. Section 5: Your Experiences visiting with us over the last year or so
We’d like you to think more broadly…about your experiences with us OVER THE LAST YEAR OR SO
The last time you were sick or concerned you had a health problem,

	Yes	No
Did you get an appointment on the day you wanted?	Did you get an appointment on the day you wanted? Yes	Did you get an appointment on the day you wanted? No

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* 13. Section 5: Your Experiences visiting with us over the last year or so
We’d like you to think more broadly…about your experiences with us OVER THE LAST YEAR OR SO
The last time you were sick or concerned you had a health problem,

	Same Day	Next Day	2-19 days	20+ days	Don't know/Don't want to answer
How many days did it take from when you first tried to see your educator to when you actually spoke or saw them or someone else in their centre?	How many days did it take from when you first tried to see your educator to when you actually spoke or saw them or someone else in their centre? Same Day	How many days did it take from when you first tried to see your educator to when you actually spoke or saw them or someone else in their centre? Next Day	How many days did it take from when you first tried to see your educator to when you actually spoke or saw them or someone else in their centre? 2-19 days	How many days did it take from when you first tried to see your educator to when you actually spoke or saw them or someone else in their centre? 20+ days	How many days did it take from when you first tried to see your educator to when you actually spoke or saw them or someone else in their centre? Don't know/Don't want to answer

If between 2-19 days, enter the number of days:

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* 14. When you see your educator, how often do they or someone else in the centre:

	Never	Rarely	Sometimes	Often	Always
Give you an opportunity to ask questions about recommended treatment	Give you an opportunity to ask questions about recommended treatment Never	Give you an opportunity to ask questions about recommended treatment Rarely	Give you an opportunity to ask questions about recommended treatment Sometimes	Give you an opportunity to ask questions about recommended treatment Often	Give you an opportunity to ask questions about recommended treatment Always
Involve you as much as you want to be in decisions about your care and treatment	Involve you as much as you want to be in decisions about your care and treatment Never	Involve you as much as you want to be in decisions about your care and treatment Rarely	Involve you as much as you want to be in decisions about your care and treatment Sometimes	Involve you as much as you want to be in decisions about your care and treatment Often	Involve you as much as you want to be in decisions about your care and treatment Always
Spend enough time with you	Spend enough time with you Never	Spend enough time with you Rarely	Spend enough time with you Sometimes	Spend enough time with you Often	Spend enough time with you Always

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* 15. At some point during your visits, were you provided educational resources and if so did you find them useful and easy to understand?

Yes

N/A

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* 16. Thinking about the health care providers that you have seen (in person/virtually) over the last year or so:

	Never	Rarely	Sometimes	Often	Always
Do you prefer virtual or in person appointments?	Do you prefer virtual or in person appointments? Never	Do you prefer virtual or in person appointments? Rarely	Do you prefer virtual or in person appointments? Sometimes	Do you prefer virtual or in person appointments? Often	Do you prefer virtual or in person appointments? Always
Were you offered the option of virtual or in person appointment?	Were you offered the option of virtual or in person appointment? Never	Were you offered the option of virtual or in person appointment? Rarely	Were you offered the option of virtual or in person appointment? Sometimes	Were you offered the option of virtual or in person appointment? Often	Were you offered the option of virtual or in person appointment? Always

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* 17. Have you had a hospital admission within the last 12 months?

Yes

Not applicable (don’t know or do not wish to answer)

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* 18. After discharge from the hospital, the centre booked/offered me an appointment?

Within 48 hours

More than 48 hours

Did not feel I required an appointment

Not applicable (don’t know or do not wish to answer)

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* 19. The last time when you needed medical care in the evening, on the weekend or on a public holiday, how easy was it to get care without going to the emergency department?

Not Applicable

Very Easy

Somewhat Easy

Somewhat Difficult

Very Difficult

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* 20. In general how would you rate your overall health?

Poor

Fair

Good

Very Good

Excellent

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* 21. How long have you been visiting us for your health care?

This is my first visit

Less than six months

Between six months and a year

Between one and three years

Between three to five years

Longer than five years

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* 22. Are you aware of other services within our organization or have you been referred to/or used any other services?

Yes

N/A

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* 23. Would you recommend our services to your family or friends?

Definitely Yes

Probably Yes

Definitely No

Probably No

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* 24. Thinking of your overall experience with our centre, what are:

One thing we have done particularly well?

One thing that could be improved?

Diabetes Wellness Survey

Client Experience Survey 2023

Question Title

* 1. Are you completing this survey for yourself or for another person?

Question Title

* 2. If you are completing this survey for someone else, who are you completing it for?

Question Title

* 3. Location / Program where you receive services:

Question Title

* 4. Section 1: Contacting UsHow was the appointment for your most recent visit made?

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* 5. Section 1: Contacting UsThinking about your most recent visit, on a scaleof poor to excellent, how would you rate the following …

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* 6. Section 2: Arriving and Waiting at the Centre On a scale of poor to excellent, how would you rate the following:

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* 7. Section 3: Your AppointmentThinking about the MAIN health care provider you spoke with during a visit, on a scale of poor to excellent, how would you rate this person on the following:

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* 8. I feel comfortable and welcomed at weCHC.

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* 9. Have you spoken to your educator recently about your retinopathy screening?

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* 10. Have you spoken to you educator recently about foot health?

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* 11. Section 4: Your Overall Experience With Your Most Recent VisitThinking about your most recent visit, on a scale of poor to excellent, how would you rate the following:

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* 12. Section 5: Your Experiences visiting with us over the last year or soWe’d like you to think more broadly…about your experiences with us OVER THE LAST YEAR OR SOThe last time you were sick or concerned you had a health problem,

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* 13. Section 5: Your Experiences visiting with us over the last year or soWe’d like you to think more broadly…about your experiences with us OVER THE LAST YEAR OR SOThe last time you were sick or concerned you had a health problem,

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* 14. When you see your educator, how often do they or someone else in the centre:

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* 15. At some point during your visits, were you provided educational resources and if so did you find them useful and easy to understand?

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* 16. Thinking about the health care providers that you have seen (in person/virtually) over the last year or so:

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* 17. Have you had a hospital admission within the last 12 months?

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* 18. After discharge from the hospital, the centre booked/offered me an appointment?

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* 19. The last time when you needed medical care in the evening, on the weekend or on a public holiday, how easy was it to get care without going to the emergency department?

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* 20. In general how would you rate your overall health?

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* 21. How long have you been visiting us for your health care?

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* 22. Are you aware of other services within our organization or have you been referred to/or used any other services?

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* 23. Would you recommend our services to your family or friends?

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* 24. Thinking of your overall experience with our centre, what are:

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* 25. Is there any additional information or feedback you would like to share with us that could help us improve the way we provide care?

* 4. Section 1: Contacting Us
How was the appointment for your most recent visit made?

* 5. Section 1: Contacting Us
Thinking about your most recent visit, on a scale
of poor to excellent, how would you rate the following …

* 6. Section 2: Arriving and Waiting at the Centre
On a scale of poor to excellent, how would you rate the following:

* 7. Section 3: Your Appointment
Thinking about the MAIN health care provider you spoke with during a visit, on a scale of poor to excellent, how would you rate this person on the following:

* 11. Section 4: Your Overall Experience With Your Most Recent Visit
Thinking about your most recent visit, on a scale of poor to excellent, how would you rate the following:

* 12. Section 5: Your Experiences visiting with us over the last year or so
We’d like you to think more broadly…about your experiences with us OVER THE LAST YEAR OR SO
The last time you were sick or concerned you had a health problem,

* 13. Section 5: Your Experiences visiting with us over the last year or so
We’d like you to think more broadly…about your experiences with us OVER THE LAST YEAR OR SO
The last time you were sick or concerned you had a health problem,