Skip to content

2026 Respiratory Virus Immunization Clinic

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. My privacy was respected as best it could be.
Information Sharing:
(If question does not apply, leave blank)
Always
Usually
Sometimes
Never
a. My healthcare provider used words I could understand.
Participation:
(If question does not apply, leave blank)
Always
Usually
Sometimes
Never
a. My choices were respected.
Accessibility and Responsiveness:
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
a. I had access to the care I needed.
Quality:
(If question does not apply, leave blank)
Always
Usually
Sometimes
Never
a.  I saw the healthcare provider(s) clean their hands before providing my care.
b. My identity was confirmed before receiving care. (e.g. confirmed my name, checked my MB Health card)
Quality:
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
c. Overall, I was satisfied with the quality of care I received.
a. How did you learn about the Respiratory Virus Immunization Clinic?
(Check all that apply)
Respiratory Virus Immunization Clinic Program Specific Questions:
(If question does not apply, leave blank)
Strongly Agree
Agree
Disagree
Strongly Disagree
b. Information about this clinic was easy to find.
c. I had an opportunity to ask questions before receiving my immunization.
e. Which community did you receive your immunization(s) at today?
Comments:
d. What would make future clinics better for you?
Demographics: (of the patient) Collected for statistical purposes only to target improvements.
Gender:
Ethnicity (Race):
Age:
Forward additional concerns or compliments regarding your care to Patient Relations.
Patient Relations: email patientrelations@pmh-mb.ca or
call 1-800-735-6596


Respiratory Virus Immunization Clinic Patient Partner Volunteers Needed!! Someone just like you helped to design this survey!
We want to partner with existing Respiratory Virus Immunization Clinic 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!