Client Experience Questionnaire

Tell us about your experience! Your feedback helps us to improve the way we provide care.

This questionnaire was built upon our Patient Values (Dignity, Respect and Trust, Information Sharing, Participation, Accessibility and Responsiveness, and Quality).

Forward additional Concerns or Compliments regarding your care to Patient Relations.
(email [email protected] or call 1-800-735-6596)

Thank you for your participation!

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If you are interested in this, please complete a Volunteer Contact Information form.

	Strongly disagree	Disagree	Agree	Strongly agree
I was treated with respect.
My privacy was respected as best it could be.
My cultural needs were considered.
Before providing care, staff members introduced themselves to me, where appropriate.
In general, staff were compassionate.

	Always	Usually	Sometimes	Never
Staff talked to me about what medications I am taking at home. (e.g. prescription, supplements, herbal, etc.)
Staff talked to me about my health care options. (e.g. procedures/tests/treatments)
My health care provider used words I could understand.
I had the necessary information needed to make good decisions about my health.
The staff kept my information confidential and secure.

	Always	Usually	Sometimes	Never
Staff involved me or my family/support system in making decisions about my care.
I was encouraged to take part in my care as much as I was able.
My choices were respected.
I was comfortable expressing concerns about my care.

	Strongly disagree	Disagree	Agree	Strongly agree
My care was well coordinated.
I was cared for in a timely manner.
I had access to the care I needed.
My concerns were taken seriously.

	Always	Usually	Sometimes	Never
I saw the health care provider(s) clean their hands before providing my care.
My identity was confirmed before receiving care. (e.g. asked my name, checked my wrist band, asked my date of birth).

Client Experience Questionnaire

Client Experience Questionnaire

Demographics

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