We are asking for your help to improve our programs at Somerset West Community Health Centre (SWCHC). We want to know what you think about how we are doing and what we can do better. We want your honest opinions. Your name does not appear anywhere on this survey. Your answers are confidential. There will be no effect on the service you receive if you choose not to answer these questions.

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* 1. What location do you normally go to?

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* 2. In the last one (1) year, what types of services or programs have you accessed (check all that apply)?

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* 3. When you had an in-person visit, how many days did it take from when you first tried to see your doctor or nurse practitioner to when you actually saw him/her in their office?

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* 4. I am aware that I can use the walk-in services if I cannot get an appointment?

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* 5. Did you experience any of the following issues or concerns with your virtual visit/group program? (select all that apply):

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* 6. Did you experience any of the following benefits from having the visit/group program virtually instead of in-person? (select all that apply):

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* 7. How likely are you to choose to receive care or take part in a program virtually again?

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* 8. What programs or services do you use at SWCHC? Please check all that apply to you.

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* 9. When you use our services, how often does our staff:

  Always Often Sometimes Rarely Never
Do they involve you as much as you want in decisions about your care and treatment?
Do they treat you with courtesy and respect?
Do they spend enough time with you?

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* 10. Please select the most appropriate response

  Strongly Agree Agree Neither agree nor disagree Disagree Strongly disagree
Because of visiting or using the services of SWCHC I feel more connected to my community
The programs and services at SWCHC have helped me improve my (or my family's) health and well-being
Because of visiting or using the services at SWCHC, I have learned more about the resources available in my community
I always feel comfortable and welcome at SWCHC
I feel safe accessing services at SWCHC
I know how to make a suggestion or a complaint
Overall, I am satisfied with the services or programs  I received at SWCHC

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* 11. Do you have any comments or suggestions for us about our services?

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* 12. Which of the following best describes your racial or ethnic group?

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* 13. What is your mother tongue (the language that you first learned at home in childhood and still understand)? (check only one)

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* 14. Were you born outside of Canada?

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* 15. What is your gender?

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* 16. What is your sexual orientation? (check one only)

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* 17. What was your total household income before taxes last year?

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* 18. Do  you have any disabilities?

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* 19. Is there anything else you would like to tell us about the services we provide?

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