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Maternity Services March 1, 2026 - September 1, 2026

Client Experience Questionnaire

Tell us about your experience!  Your feedback helps us to improve the way we provide care.  This questionnaire was built upon our Patient Values (Dignity, Respect and Trust, Information Sharing, Participation, Accessibility and Responsiveness, and Quality).

We do not collect personal information unless you request a follow-up.

If the question does not apply, please leave blank.
Dignity, Respect and Trust:
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
a.  I was treated with respect.
b.  My privacy was respected as best it could be.
c.  My cultural needs were considered.  (e.g. individuals’ own beliefs, customs, social standards, traditions or religious beliefs)
d. Before providing care, staff members introduced themselves to me, where appropriate.
e. In general, staff were compassionate.
Information Sharing:
(If question does not apply, leave blank)
Always
Usually
Sometimes
Never
a.  Staff talked to me about what medications I am taking at home.  (e.g. prescription, supplements, herbal, etc.)
b.  Staff talked to me about my health care options.  (e.g. procedures/tests)
c.  My health care provider used words I could understand.
d.  I had the necessary information needed to make good decisions about my health.
e.  The staff kept my information confidential and secure.
Participation:
(If question does not apply, leave blank)
Always
Usually
Sometimes
Never
a.  Staff involved me or my family/support system in making decisions about my care.
b.  I was encouraged to take part in my care as much as I was able.
c.  My choices were respected.
d.  I was comfortable expressing concerns about my care.
Accessibility and Responsiveness:
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
a.  My care was well coordinated.
b.  I was cared for in a timely manner.
c.  I had access to the care I needed.
d.  My concerns were taken seriously.
e. I am aware of the Prairie Mountain Health (PMH) services and programs available to get the support I need for my health care journey.
Quality:
(If question does not apply, leave blank)
Always
Usually
Sometimes
Never
a.  I saw the health care provider(s) clean their hands before providing my care.
b.  My identity was confirmed before receiving care.  (e.g. asked my name, checked my wrist band, asked my date of birth)
Quality:
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
c. My healthcare provider discussed risks or hazards that could cause falls/slips/trips (e.g. proper footwear, wet floors, icy side walks, uneven surfaces, electrical cords, etc.).
d.  I felt staff were up to date on the skills needed to provide my care.
e.  Overall, I was satisfied with the quality of care I received.
a. Did you have barriers in receiving prenatal care? (i.e. appointment availability, location of appointment, etc.)
Maternity Services Program Specific Questions -
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
b. Upon admission, I was asked if I had a birth plan.
c. My health care team worked together to meet my birth plan needs as best possible.
d. I was satisfied with the care provided:
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
1.  During labor
2. In my care after birth
3. Related to my newborn(s)' care
Maternity Program Specific Questions -
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
e.  I was involved with decisions on my newborn(s)’ care.
f. Staff provided me with ongoing support on how to feed my baby.
g. I found the teaching booklet “Caring for Yourself After Baby is Born” helpful.
h. I found the teaching booklet “Caring for Baby” helpful.
i. I was given enough information on available supports after discharge (e.g. Public Health, Mental Health, La Leche League)
j. I was supported/encouraged to talk about my birth experience prior to being discharged.
Maternity Services Program Specific Questions -
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
N/A
k. I was encouraged/supported to do skin to skin in the first hour of delivery.
l. Staff provided me with ongoing support for breastfeeding throughout my hospital stay.
Please provide any suggestions to improve our services:
Demographics: (of the patient) Collected for statistical purposes only to target improvements.
Is this your first baby?
Ethnicity
Age:
Where did you receive care?
My baby was delivered by:
Forward additional concerns or compliments regarding your care to Patient Relations.
Patient Relations: email patientrelations@pmh-mb.ca or
call 1-800-735-6596


Maternity Services Patient Partner Volunteers Needed!! Someone just like you helped to design this survey!
We want to partner with existing Maternity patients or family members who might be interested in helping us review, design or
provide feedback to our services.


If you would like more information or if you think you might be interested in becoming a Patient Partner, please click on the link below or contact Patient Relations by calling 1-800-735-6596.

https://prairiemountainhealth.ca/forms/patient-partner/
Questions or concerns related to this survey can be sent to ceq@pmh-mb.ca

Thank you for your participation!