Thank you for filling in this survey. Your feedback helps us to provide better service.

This survey is anonymous, and optional. You can choose not to do it, or you can stop at any time, and you can still use health unit services now and in the future.

You can also fill out a paper version of this survey in any of our offices or send us an email with your comments at

This survey has 7 questions and should take less than 5 minutes to complete. We ask some questions about to help us know if everyone who comes here has the same experience.

If you have any questions or comments, talk to a staff person.

Thank you.

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* 1. Please indicate your level of agreement with the statements below:

  Strongly disagree Disagree Neither disagree or agree Agree Strongly Agree
The amount of time it took to get the service was acceptable.
The time and location of the service was convenient.
I was treated well by health unit staff. They were friendly, courteous, helpful and respectful.
The health unit staff person had the knowledge and skills to help me.
I was satisfied with the quality of the service I received.
Overall, I got the information and /or service that I needed.

Please tell us about you. This will help us know who is using our services, and if everyone who comes here has the same experience.

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* 2. What office location did you go to?

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* 3. How old are you?

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* 4. Do you identify as (check all that apply):

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* 5. What is your approximate household income per year (before taxes)?

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* 6. How do you define your gender? (e.g. female, male, another way, prefer not to answer)

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* 7. How many people (#) live in your household?

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* 8. Any additional comments?

For privacy reasons, we don't collect names and/or contact information online. This means that we cannot respond to any comments you included here.

If you would like to talk to someone about your feedback, please email us at or call your local health unit office.

Adapted from Rand Health Visit-Specific Satisfaction Instrument (VSQ-9)