Telehealth Exit Survey - Old Version

We value your feedback so we can improve our services.

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* 1. Program

1 day

2 day

4 day

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* 2. Tick one box in each line below

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree	Not Applicable
I was treated with respect	I was treated with respect Strongly Agree	I was treated with respect Agree	I was treated with respect Neutral	I was treated with respect Disagree	I was treated with respect Strongly Disagree	I was treated with respect Not Applicable
I was given information about my rights	I was given information about my rights Strongly Agree	I was given information about my rights Agree	I was given information about my rights Neutral	I was given information about my rights Disagree	I was given information about my rights Strongly Disagree	I was given information about my rights Not Applicable
I feel more confident about parenting	I feel more confident about parenting Strongly Agree	I feel more confident about parenting Agree	I feel more confident about parenting Neutral	I feel more confident about parenting Disagree	I feel more confident about parenting Strongly Disagree	I feel more confident about parenting Not Applicable
I was given consistent information	I was given consistent information Strongly Agree	I was given consistent information Agree	I was given consistent information Neutral	I was given consistent information Disagree	I was given consistent information Strongly Disagree	I was given consistent information Not Applicable
Staff worked with me to set goals	Staff worked with me to set goals Strongly Agree	Staff worked with me to set goals Agree	Staff worked with me to set goals Neutral	Staff worked with me to set goals Disagree	Staff worked with me to set goals Strongly Disagree	Staff worked with me to set goals Not Applicable
I achieved my goals	I achieved my goals Strongly Agree	I achieved my goals Agree	I achieved my goals Neutral	I achieved my goals Disagree	I achieved my goals Strongly Disagree	I achieved my goals Not Applicable
I was involved in making decisions about support	I was involved in making decisions about support Strongly Agree	I was involved in making decisions about support Agree	I was involved in making decisions about support Neutral	I was involved in making decisions about support Disagree	I was involved in making decisions about support Strongly Disagree	I was involved in making decisions about support Not Applicable
Information provided was easy to understand	Information provided was easy to understand Strongly Agree	Information provided was easy to understand Agree	Information provided was easy to understand Neutral	Information provided was easy to understand Disagree	Information provided was easy to understand Strongly Disagree	Information provided was easy to understand Not Applicable
I felt that I could speak up if needed	I felt that I could speak up if needed Strongly Agree	I felt that I could speak up if needed Agree	I felt that I could speak up if needed Neutral	I felt that I could speak up if needed Disagree	I felt that I could speak up if needed Strongly Disagree	I felt that I could speak up if needed Not Applicable
My cultural needs were respected and met	My cultural needs were respected and met Strongly Agree	My cultural needs were respected and met Agree	My cultural needs were respected and met Neutral	My cultural needs were respected and met Disagree	My cultural needs were respected and met Strongly Disagree	My cultural needs were respected and met Not Applicable
I would recommend QEC to other families	I would recommend QEC to other families Strongly Agree	I would recommend QEC to other families Agree	I would recommend QEC to other families Neutral	I would recommend QEC to other families Disagree	I would recommend QEC to other families Strongly Disagree	I would recommend QEC to other families Not Applicable
Staff worked together to provide support	Staff worked together to provide support Strongly Agree	Staff worked together to provide support Agree	Staff worked together to provide support Neutral	Staff worked together to provide support Disagree	Staff worked together to provide support Strongly Disagree	Staff worked together to provide support Not Applicable

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* 3. Was the referral process easy?

Yes

No

Comment:

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* 4. If you received an 'assessment and intake' advice phone call from our nurse, was it helpful?

Yes

No

Not applicable

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* 5. What was your main reason for contacting QEC?

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* 6. Was this main reason/concern addressed?

Yes

No

Comment:

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* 7. QEC has only recently started using Telehealth to provide support to families. Could you share with us - what worked well and what could be improved in how we deliver Telehealth?

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* 8. Are you interested in learning about how you can help QEC to improve its services (optional)?

No

Yes

If yes, your name and email address:

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* 9. Please share any other comments or suggestions