You recently received care and services at the hospital following a sexual assault. To help us continue to improve our services, we would like to learn your opinion of the quality of care and services you received related directly to this experience.
 
Your participation is voluntary.
 
The information gathered is not anonymous but will remain confidential. A limited number of people will have access to the answers and the results will be presented as a whole.
Please add your comments and suggestions in the block provided in the last question.
 
This questionnaire should take about 5 minutes to complete.
If you have any questions or comments about this questionnaire, contact: William Provost

Email: william.provost.cissslau@ssss.gouv.qc.ca

Thank you for your cooperation!

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* 1. Where did you receive the services?

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* 2. What is your age group? (If completing for someone else, please check the box that corresponds to the person who received the care and services.)

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* 3. During this hospital visit, how do you rate the waiting time before your first contact with the psychosocial caseworker?

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* 4. The healthcare professionals treated me politely and respectfully (e.g.: nurse, psychosocial counsellor, doctor).

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* 5. The healthcare professionals listened attentively to me.

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* 6. The healthcare professionals spoke to me in an easy-to-understand way.

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* 7. I participated in the decisions that affected me.

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* 8. I had to repeat information about myself to different healthcare professionals.

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* 9. I felt safe during my time at the hospital.

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* 10. I received information about the services and organizations that can help me.

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* 11. Are you satisfied with the care and services you received?

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* 12. What comments and suggestions do you have to improve the services we provide to victims of sexual assault who come to the hospital?

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