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* 1. Who did you see during your last visit to Sandy Hill CHC?

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* 2. How long have you been receiving services/ working with Sandy Hill CHC staff?

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* 3. Do you feel engaged and connected to Sandy Hill CHC?

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* 4. Has the COVID-19 pandemic impacted your access to services at Sandy Hill CHC?

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* 5. Since the COVID-19 pandemic, have you received services from Sandy Hill CHC (including virtual visits, online groups and calls by phone)?

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* 6. How strongly do you Agree or Disagree with the following statements:

Being involved with (or coming to) the centre has helped improve my health/ well-being (or that of my child).

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* 7. Based on my needs and how I identify, the service and care I receive at SHCHC is respectful of my culture, beliefs and values.

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* 8. I feel safe at Sandy Hill CHC.

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* 9. I am satisfied with the language of services I received.

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* 10. Because of my contact with Sandy Hill CHC, I feel more connected with my community.

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* 11. Because of my contact with Sandy Hill CHC, I learned more about other resources in the community.

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* 12. The last time you were sick or were concerned you had a health problem...

Did you get an appointment on the date you wanted?

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* 13. How many days did it take from when you first tried to see a doctor or nurse practitioner to when you actually had an appointment with them or someone else in the office?

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* 14. How often does your service provider (doctor, nurse practitioner or other staff member) involve you as much as you want to be in decisions about your care and treatment?

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* 15. Are you treated by your service provider with dignity (with courtesy and respect)?

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* 16. Overall, how would you rate the quality of the care/ services you received from Sandy Hill CHC?

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* 17. What Sandy Hill CHC services have you accessed in the last 6 months (please check all that apply):

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* 18. Please describe any other services or programs that you would like to be able to access at Sandy Hill CHC (optional):

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* 19. If a service was not available at Sandy Hill CHC, were you connected to other services or outside agencies?

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* 20. We strive to provide the best care possible, but recognize we can always improve. Were you dissatisfied with any of the above areas? If you would like to provide more feedback, we welcome your comments.

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* 21. What does your Postal Code start with?

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* 22. How old are you?

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* 23. To help us better plan our programs and services, please tell us about yourself (optional):

Gender Identity is your sense of self, for example, your sense of being male, female, both or neither.  It may be diffferent from your physical sex and includes the options below (check one only):

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* 24. Sexual Orientation is who you are attracted to romantically.  People define their sexual orientation in various ways.  What is your sexual orientation?

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* 25. Education.  What is yoru highest completed level of education?

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* 26. What best describes your ethnic or racial group? (Please check all that apply)

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* 27. Health and Accessibility (any ongoing condition(s) you want us to know about):

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* 28. Income (Combined Annual Household income):

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* 29. How many people are supported by this income?

Thank You * Merci * Miigwech

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