Outpatient Client Experience Survey

Laboratory

Surgical Unit

X-Ray

Ultrasound

CT Scan

Mammography

Pain Management Clinic

Day Medicine

Rehabilitation Department (Physiotherapy, Occupational Therapy, Kinesiologist, Speech-Language Therapy, Cardiac Rehab Clinic, Fracture Clinic)

Telemedicine

Chemotherapy

IPP (Integrated Prenatal Program)

Diabetes Program

Chronic Disease Program

Pediatric Clinic

Other (please type in which other department you attended today)

	Never	Sometimes	Usually	Always	Don't Know/Not Applicable
Did staff introduce themselves to you?	Did staff introduce themselves to you? Never	Did staff introduce themselves to you? Sometimes	Did staff introduce themselves to you? Usually	Did staff introduce themselves to you? Always	Did staff introduce themselves to you? Don't Know/Not Applicable
Did staff explain their role before they offered care?	Did staff explain their role before they offered care? Never	Did staff explain their role before they offered care? Sometimes	Did staff explain their role before they offered care? Usually	Did staff explain their role before they offered care? Always	Did staff explain their role before they offered care? Don't Know/Not Applicable
Were you satisfied with the care you received?	Were you satisfied with the care you received? Never	Were you satisfied with the care you received? Sometimes	Were you satisfied with the care you received? Usually	Were you satisfied with the care you received? Always	Were you satisfied with the care you received? Don't Know/Not Applicable
Did staff explain your care to you?	Did staff explain your care to you? Never	Did staff explain your care to you? Sometimes	Did staff explain your care to you? Usually	Did staff explain your care to you? Always	Did staff explain your care to you? Don't Know/Not Applicable
Did the staff answer your questions and concerns in a way that you could understand?	Did the staff answer your questions and concerns in a way that you could understand? Never	Did the staff answer your questions and concerns in a way that you could understand? Sometimes	Did the staff answer your questions and concerns in a way that you could understand? Usually	Did the staff answer your questions and concerns in a way that you could understand? Always	Did the staff answer your questions and concerns in a way that you could understand? Don't Know/Not Applicable
Were you satisfied that you had enough say in decision making about your care?	Were you satisfied that you had enough say in decision making about your care? Never	Were you satisfied that you had enough say in decision making about your care? Sometimes	Were you satisfied that you had enough say in decision making about your care? Usually	Were you satisfied that you had enough say in decision making about your care? Always	Were you satisfied that you had enough say in decision making about your care? Don't Know/Not Applicable

Never

Sometimes

Usually

Always

Don't Know/Not Applicable

Did staff introduce themselves to you?

Did staff introduce themselves to you? Never

Did staff introduce themselves to you? Sometimes

Did staff introduce themselves to you? Usually

Did staff introduce themselves to you? Always

Did staff introduce themselves to you? Don't Know/Not Applicable

Did staff explain their role before they offered care?

Did staff explain their role before they offered care? Never

Did staff explain their role before they offered care? Sometimes

Did staff explain their role before they offered care? Usually

Did staff explain their role before they offered care? Always

Did staff explain their role before they offered care? Don't Know/Not Applicable

Were you satisfied with the care you received?

Were you satisfied with the care you received? Never

Were you satisfied with the care you received? Sometimes

Were you satisfied with the care you received? Usually

Were you satisfied with the care you received? Always

Were you satisfied with the care you received? Don't Know/Not Applicable

Did staff explain your care to you?

Did staff explain your care to you? Never

Did staff explain your care to you? Sometimes

Did staff explain your care to you? Usually

Did staff explain your care to you? Always

Did staff explain your care to you? Don't Know/Not Applicable

Did the staff answer your questions and concerns in a way that you could understand?

Did the staff answer your questions and concerns in a way that you could understand? Never

Did the staff answer your questions and concerns in a way that you could understand? Sometimes

Did the staff answer your questions and concerns in a way that you could understand? Usually

Did the staff answer your questions and concerns in a way that you could understand? Always

Did the staff answer your questions and concerns in a way that you could understand? Don't Know/Not Applicable

Were you satisfied that you had enough say in decision making about your care?

Were you satisfied that you had enough say in decision making about your care? Never

Were you satisfied that you had enough say in decision making about your care? Sometimes

Were you satisfied that you had enough say in decision making about your care? Usually

Were you satisfied that you had enough say in decision making about your care? Always

Were you satisfied that you had enough say in decision making about your care? Don't Know/Not Applicable

	Never	Sometimes	Usually	Always	Don't Know/Not Applicable
Were you satisfied with the customer service from our staff?	Were you satisfied with the customer service from our staff? Never	Were you satisfied with the customer service from our staff? Sometimes	Were you satisfied with the customer service from our staff? Usually	Were you satisfied with the customer service from our staff? Always	Were you satisfied with the customer service from our staff? Don't Know/Not Applicable
Did staff treat you with courtesy and respect?	Did staff treat you with courtesy and respect? Never	Did staff treat you with courtesy and respect? Sometimes	Did staff treat you with courtesy and respect? Usually	Did staff treat you with courtesy and respect? Always	Did staff treat you with courtesy and respect? Don't Know/Not Applicable
Were staff sensitive to your needs?	Were staff sensitive to your needs? Never	Were staff sensitive to your needs? Sometimes	Were staff sensitive to your needs? Usually	Were staff sensitive to your needs? Always	Were staff sensitive to your needs? Don't Know/Not Applicable
Were you or your caregiver asked what your needs or cultural values are when making decisions about your care?	Were you or your caregiver asked what your needs or cultural values are when making decisions about your care? Never	Were you or your caregiver asked what your needs or cultural values are when making decisions about your care? Sometimes	Were you or your caregiver asked what your needs or cultural values are when making decisions about your care? Usually	Were you or your caregiver asked what your needs or cultural values are when making decisions about your care? Always	Were you or your caregiver asked what your needs or cultural values are when making decisions about your care? Don't Know/Not Applicable
Were your preferences taken into account when providing care?	Were your preferences taken into account when providing care? Never	Were your preferences taken into account when providing care? Sometimes	Were your preferences taken into account when providing care? Usually	Were your preferences taken into account when providing care? Always	Were your preferences taken into account when providing care? Don't Know/Not Applicable
Were you satisfied with the overall care you received today?	Were you satisfied with the overall care you received today? Never	Were you satisfied with the overall care you received today? Sometimes	Were you satisfied with the overall care you received today? Usually	Were you satisfied with the overall care you received today? Always	Were you satisfied with the overall care you received today? Don't Know/Not Applicable

Never

Sometimes

Usually

Always

Don't Know/Not Applicable

Were you satisfied with the customer service from our staff?

Were you satisfied with the customer service from our staff? Never

Were you satisfied with the customer service from our staff? Sometimes

Were you satisfied with the customer service from our staff? Usually

Were you satisfied with the customer service from our staff? Always

Were you satisfied with the customer service from our staff? Don't Know/Not Applicable

Did staff treat you with courtesy and respect?

Did staff treat you with courtesy and respect? Never

Did staff treat you with courtesy and respect? Sometimes

Did staff treat you with courtesy and respect? Usually

Did staff treat you with courtesy and respect? Always

Did staff treat you with courtesy and respect? Don't Know/Not Applicable

Were staff sensitive to your needs?

Were staff sensitive to your needs? Never

Were staff sensitive to your needs? Sometimes

Were staff sensitive to your needs? Usually

Were staff sensitive to your needs? Always

Were staff sensitive to your needs? Don't Know/Not Applicable

Were you or your caregiver asked what your needs or cultural values are when making decisions about your care?

Were you or your caregiver asked what your needs or cultural values are when making decisions about your care? Never

Were you or your caregiver asked what your needs or cultural values are when making decisions about your care? Sometimes

Were you or your caregiver asked what your needs or cultural values are when making decisions about your care? Usually

Were you or your caregiver asked what your needs or cultural values are when making decisions about your care? Always

Were you or your caregiver asked what your needs or cultural values are when making decisions about your care? Don't Know/Not Applicable

Were your preferences taken into account when providing care?

Were your preferences taken into account when providing care? Never

Were your preferences taken into account when providing care? Sometimes

Were your preferences taken into account when providing care? Usually

Were your preferences taken into account when providing care? Always

Were your preferences taken into account when providing care? Don't Know/Not Applicable

Were you satisfied with the overall care you received today?

Were you satisfied with the overall care you received today? Never

Were you satisfied with the overall care you received today? Sometimes

Were you satisfied with the overall care you received today? Usually

Were you satisfied with the overall care you received today? Always

Were you satisfied with the overall care you received today? Don't Know/Not Applicable

1 - WORST

10 - BEST

1 - WORST

10 - BEST

Outpatient Client Experience Survey

Question Title

* 1. What department(s) did you attend today?

Question Title

* 2. Please answer the following questions about your visit today.

Question Title

* 3. Please answer the following questions about your visit today.

Question Title

* 4. Please rate SLMHC using any number from 1 - 10, where 1 is the WORST health centre possible and 10 is the BEST health centre possible.

Question Title

* 5. Would you recommend the Sioux Lookout Meno Ya Win Health Centre to friends and/or family?

Question Title

* 6. Is there anything else you would like to tell us about your most recent visit to the Sioux Lookout Meno Ya Win Health Centre?