Welcome

Thank you for taking the time to complete the following survey and provide your feedback. Should you require assistance at any time please speak with a CHIGAMIK staff member at the front desk. The survey will take approximately 5-10 minutes to complete. Please read all of the questions carefully and select the response that best reflects your experience. If a question does not apply to you please select “not applicable”. If any of the questions make you feel uncomfortable and you do not wish to provide an answer please select "Prefer not to Answer". You may also skip questions or end the survey at any time and are not required to provide a reason.

All information provided is voluntary and will remain anonymous and confidential. Please note, throughout the survey the word “Staff” refers to all staff members who may interact with you. This includes but is not limited to nurses, nurse practitioners, doctors, social workers, dietitians, health promoters, community health workers and the front desk staff.

Thank you for taking the time to provide your feedback. The information collected from this survey will be used to enhance existing programs and services, implement new initiatives, develop funding proposals and support ongoing research.

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* 1. I have been receiving services from CSC CHIGAMIK CHC (CHIGAMIK) for

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* 2. I always feel welcome and comfortable at CHIGAMIK ...

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* 3. I am greeted in a warm, welcoming, calm and non-judgmental manner by reception staff...

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* 4. The last time I needed medical care in the evening, weekend, or public holiday, it was possible to obtain care without going to the hospital emergency department...

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* 5. Self-identi fication is essential to the provision of the best health care and important to us at CHIGAMIK. Please indicate if you self-identify with any of the groups listed below...

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* 6. Staff take into account my individual needs when they are providing care (i.e. language, culture, literacy, special needs, sexual orientation, gender, etc.) ...

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* 7. What gender do you identify with...

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* 8. What is your sexual orientation...

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* 9. CHIGAMIK staff are sensitive to my cultural needs ...

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* 10. I am satisfi ed with the quality of services I receive in the language I request...

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* 11. Do you currently receive Primary Care Services (visits with a Doctor or Nurse Practitioner) at CHIGAMIK...

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* 12. The last time you requested an appointment with your health care provider at CHIGAMIK, how long did it take to meet with or hear from them?

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* 13. When you see health care providers at CHIGAMIK, how often do they...

  Always Often Sometimes Rarely Never Not Applicable Prefer not to Answer
give you opportunities to ask questions about recommended treatment...
involve you in decisions about your care and treatment.
spend enough time with you...
treat you with dignity and respect...

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* 14. I know how to make a complaint about the services I receive at CHIGAMIK...

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* 15. I am aware of the different programs and services offered at CHIGAMIK and how to access them

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* 16. As a result of services received at CHIGAMIK:

  Strongly Agree Agree Not Sure Disagree Strongly Disagree Not Applicable Prefer not to Answer
I feel that my physical health has improved
I feel that my mental health has improved
I feel that my sense of community belonging has improved

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* 17. I would recommend programs and services offered by CHIGAMIK to my family or friends ...

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* 18. Which of the following activities, groups, or community programs, would you consider participating in ...

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* 19. Do you have any comments about the questionnaire, or suggestions to improve services at CHIGAMIK

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