Let us know your opinion about the services you received by completing this short survey.
Thank you for helping us improve!

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* 3. Date you received the service

Date

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* 4. Check the appropriate box.

  Yes No Not always Does not apply
Did the personnel show you respect (courtesy, formal modes of address)?
Did the personnel get your consent (authorization) before beginning to provide care services?
Did the personnel explain the services you would be receiving?
Were the explanations about the services easy to understand?
Did the personnel give you an opportunity to express your needs, comments or concerns?
Were you given any written information? (e.g., symptoms to watch for, explanations of your condition, etc.)
If you were referred to another department for additional care, were you given adequate explanations of what would happen next? (e.g., from the emergency room to radiology, from the hospital to the CLSC or to home care, etc.)
After having told one staff member about your problem, did you have to repeat the same information to another staff member?
Did you find the premises clean?
Did you find the premises safe (e.g., unobstructed stairs, access to entrances, etc.)?
Did you find the equipment used (e.g., wheelchairs, devices, apparatus, etc.) clean?
Did you find the equipment used (e.g., wheelchairs, devices, apparatus, etc.) safe?
Were the signs in the building easy to follow to get where you needed to go?
Did you see the personnel washing or desinfecting their hands before provinding care?
Did the personnel make sure to properly identify you before providing care? (e.g., by asking for your name and date of birth)
Would you know how to proceed if you wanted to file a complaint?

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* 5. Overall, how satisfied are you with the service you received?

0 % 100 %
i We adjusted the number you entered based on the slider’s scale.

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* 9. Comments and suggestions

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* 10. If you would like us to contact you, please supply your contact information :

Do you want to file a complaint?
By telephone : 1 844-255-7568
On the Internet : www.cisss-bsl.gouv.qc.ca
By email : plaintes.cisssbsl@ssss.gouv.qc.ca

Rest assured that the information and comments you share with us will remain confidential.
Thank you for helping to improve the care and services offered at CISSS du Bas-Saint-Laurent!

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