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Outpatient Client Experience Survey
1.
What department did you attend today?
If you attended more than one department, please feel free to complete an additional survey for each department that you attended.
Laboratory
Surgical Unit (including Ear Nose Throat or Pediatric Clinics)
Diagnostic Imaging (Xray, CT Scan, Ultrasound, Mammography, Pain Managment Clinic)
Day Medicine
Rehabilitation Department (Physiotherapy, Occupational Therapy, Kinesiology, Speech-Language Therapy, Cardiac Rehab, Fracture Clinic, Stress Testing)
Chemotherapy
IPP (Integrated Prenatal Program)
Diabetes Program
Chronic Disease Program
Other (please tell us which other department you attended today)
2.
Did you feel that you were treated with compassion and respect during your hospital visit?
Yes, always
Yes, Sometimes
No
If no, please tell us what we can do better.
3.
Did staff introduce themselves to you?
Yes, always
Yes, Sometimes
No
4.
Did staff take your cultural values, or personal preferences, and those of your family or caregiver into account when making decisions about your care?
These things may include, but are not limited to, accessibility needs, interpreter assistance, visits by clergy, elders, or spiritual leaders.
Yes, always
Usually
Sometimes
Never
If never, please tell us what we can do better.
5.
Did staff explain your condition and treatment in a way you could understand?
Yes, always
Yes, sometimes
No
6.
Did you feel you were treated in a way that was helpful and supportive to you?
Yes, always
Yes, sometimes
No
If no, please tell us what we can improve.
7.
When preparing to leave the hospital, do you have a good understanding of how to manage your health at home?
Yes, completely
Yes, somewhat
No
If no, please provide tell us what we can improve
8.
Is there anyone you would like to recognize for the care he or she provided during your stay?
Yes
No
If yes, please tell us who you would like to recognize and why.
9.
Would you recommend SLMHC to your family and friends based on the quality of care provided?
Yes
No
10.
Please rate SLMHC using any number from 1 - 10, where 1 is the WORST health centre possible and 10 is the BEST health centre possible.
1 - Worst
2
3
4
5
6
7
8
9
10 - Best
1 - Worst
2
3
4
5
6
7
8
9
10 - Best
11.
Do you have any general comments or feedback for improvement that you would like to provide?
12.
Would you like to be contacted about the information you provided in this survey?
Yes
No
If yes, please provide your name and preferred method below (phone number or email address).
13.
Would you like to add your name to a list of clients to be contacted for input on future SLMHC projects/changes?
Yes
No
If yes, please provide your name and preferred contact method below (phone number or email address).
If you would like to provide additional feedback, please ask any staff member for a Compliment/Feedback Form.
