Client Experience Questionnaire

The survey takes about 5 minutes.

Your feedback is confidential. Please do not write your name on this form. The information will be used to assist in improving service delivery to patients.

If the question does not apply, please leave blank.

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* Medical Detox In-Patient Unit Program Specific Questions:
(If the question does not apply, leave blank)

  Strongly Agree Agree Disagree Strongly Disagree
a. I was treated with respect by staff.
b. I had enough time to talk with staff about my needs.
c. Staff listened and understood my needs.
d. My cultural needs were considered. (e.g. individuals’ own beliefs, customs, social standards, traditions or religious beliefs)
e. Information was explained to me in a way I was able to understand.
f. I felt comfortable asking questions during my time at the Medical Detox In-Patient Unit.
g. I was offered assistance/support for the treatment/discharge plan of my choice.
h. I was offered mental health resources to support my needs.
i. I was involved as much as I wanted to be, in decisions about my care and treatment.
j. I would come to the Medical Detox In-Patient Unit again if I needed this type of support.
k. Overall, I was satisfied with the quality of care I received at the Medical Detox In-Patient Unit.

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* i. If you feel anything was missing at the Medical Detox In-Patient Unit, please explain.

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* Comments:

Demographics: (of the patient) Collected for statistical purposes only to target improvements.

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* Gender:

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* Can you speak French?

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* Ethnicity (Race):

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* Age:

Medical Detox In-patient Advisor Volunteers Needed!! Someone just like you helped to design this survey!
We want to partner with existing Medical Detox In-patients who might be interested in helping us review, design or provide feedback to our services. By leaving your name, phone number and email address below, you are indicating your interest in partnering with Prairie Mountain Health (PMH) and are consenting to be contacted by Patient Relations. Patient Relations will be in contact with you when an opportunity becomes available.

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* Volunteer Contact Information:

Forward additional concerns or compliments regarding your care to Patient Relations.
Patient Relations:  email   patientrelations@pmh-mb.ca    or  call   1-800-735-6596

 Questions or concerns related to this survey can be sent to ceq@pmh-mb.ca 


Thank you for your participation! 

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