Patient Experience and Satisfaction Survey
We kindly ask you to complete this survey to share feedback on your experience and satisfaction with the care you received from a CommuniCare Therapy therapist.
The responses you provide will help us improve the care we provide. The survey responses you provide are anonymous and not tracked in any way. Your participation in this survey is voluntary.
1.
What service did you receive?
Occupational Therapy
Physiotherapy
Speech Language Pathology
Dietetics
Social Work
2.
If you recall the name of your therapist, please indicate it below.
3.
Did the therapist arrange for visits at a time that was agreeable to you?
Almost always
Often
Sometimes
Rarely
Never
Cannot recall
4.
Was the therapist on time for the visits (+/- 15 minutes)?
Most of the time
Some of the time
Rarely
Never
Cannot recall
5.
Did you have any virtual visits?
Yes, over the phone
Yes, using video calls or Zoom
No all care was in person
I’m not sure
6.
Did the therapist treat you with
courtesy and respect
?
Yes
Sometimes
No
7.
Did the therapist allow you to
ask questions
or share your concerns?
Always
Very Often
Sometimes
Rarely
Never
Cannot recall
8.
Did the therapist
listen carefully
to you?
Always
Very Often
Sometimes
Rarely
Never
Cannot recall
9.
Did the therapist
explain things
in a way that you could understand?
Yes
Sometimes
No
Cannot recall
10.
Did you feel that the therapist prioritized
your safety
?
Yes
Sometimes
No
Cannot recall
11.
Did you receive services in the official language of your choice (French or English)?
Yes
Sometimes
No
Cannot recall
12.
Did the therapist ask for your input when determining your therapy goals and plan?
Yes
Cannot recall
No
13.
How would you rate the therapy recommendations, information, or resources the therapist shared with you?
Very Helpful
Somewhat Helpful
Not Helpful
No opinion
14.
Did the therapist provide their recommendations, information, or resources to you in your preferred method? (Select all that apply)
Yes in writing
Yes electronically
Cannot recall
No
15.
At the start of service did the therapist explain what services would be provided and the criteria for the end of service (discharge)?
Yes
Cannot recall
No
16.
If you requested it did the therapist include family or friends in decisions about your care as much as you wanted?
Yes
Somewhat
No
Not applicable – I did not ask for others to be included
17.
Did the therapist provide services according to the schedule and plan developed with you?
Yes
Cannot recall
No
18.
Did you improve and function better following treatment or by following the recommendations provided?
To a great extent
Somewhat
Very little
Not at all
No opinion
19.
At the end of services did the therapist explain or provide information on how you can continue to improve or maintain your progress?
Yes
Cannot recall
No
20.
Overall how satisfied are you with care you received from your CommuniCare Therapy therapist?
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied
About You
- the next questions are to help us understand the community we serve.
21.
What Home and Community Care region are you located in?
Champlain (Ottawa, Eastern Counties, North Lanark North Grenville)
South East (Leeds, Lanark, Grenville)
Unsure
22.
Are any of the items below a struggle for you? (Select all that apply)
Physical Health
Mental/Emotional Health
Finances
No
Prefer not to say
23.
What is the highest level of school you have attended?
Prefer not to say
Elementary school
High school
College, Vocational/Technical school or University
24.
If you identify with a minority group(s) please identify it below. (Select all that apply)
Not Applicable
Prefer not to say
2SLGBTQI+
Race
Ethnicity
First Nations, Inuit or Métis
Person with Disabilities
Language
Religion
I Self-Identify (please specify self-identification below):
25.
If there was something specific your therapist did that was a benefit to you and key to your satisfaction, would you please share the details below?
26.
If you have anything else to share please use the space below.
