CSCE Client Experience Survey

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* 1. At which location do you access services?

Bourget

Crysler

Embrun

Cornwall

Alexandria

Limoges

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* 2. The Centre de santé communautaire de l’Estrie is conveniently located.

Yes

Does not apply

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* 3. Over the past year, I had to go to another clinic or to the emergency room because I could not get an appointment at the Centre de santé communautaire de l’Estrie.

Yes

Does not apply

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* 4. When needed, I can get an appointment for an urgent matter with a doctor or nurse practitioner at the Centre de santé communautaire de l’Estrie.

Always

Often

Sometimes

Rarely

Never

Does not apply

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* 5. When I book an appointment at the Centre de santé communautaire de l’Estrie, I am satisfied with the date provided.

Always

Often

Sometimes

Rarely

Never

Does not apply

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* 6. After seeing a professional at the Centre de santé communautaire de l’Estrie, I can get a follow-up appointment within the time frame requested by this individual.

Always

Often

Sometimes

Rarely

Never

Does not apply

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* 7. The last time you were sick or concerned about a health problem, how many days elapsed between the time you tried to see your doctor or nurse practitioner and the time you actually SAW him/her or someone else at the Centre de santé communautaire de l’Estrie?

Same day

Next day

Two days later

Three days later

More than three days later

Does not apply

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* 8. What can the Centre de santé communautaire de l’Estrie do to improve access to its programs and services?

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* 9. My doctor or nurse practitioner allows me to ask questions about the recommended treatment.

Always

Often

Sometimes

Rarely

Never

Does not apply

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* 10. I feel that my doctor or nurse practitioner involves me in the decisions that affect my care and treatment.

Always

Often

Sometimes

Rarely

Never

Does not apply

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* 11. I feel that my doctor or nurse practitioner spends enough time with me during each visit.

Always

Often

Sometimes

Rarely

Never

Does not apply

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* 12. The employees at the Centre de santé communautaire de l’Estrie help me find community programs and services that meet my needs.

Always

Often

Sometimes

Rarely

Never

Does not apply

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* 13. The programs and services offered by the Centre de santé communautaire de l’Estrie meet my needs.

Always

Often

Sometimes

Rarely

Never

Does not apply

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* 14. I can obtain services in the language of my choice.

Always

Often

Sometimes

Rarely

Never

Does not apply

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* 15. I always feel comfortable and welcome at the Centre de santé communautaire de l’Estrie.

Always

Often

Sometimes

Rarely

Never

Does not apply

If you answered "Sometimes", "Rarely" or "Never" to the previous question, please explain why you feel this way

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* 16. When I receive services at the Centre de santé communautaire de l’Estrie, I feel that the employees respect my dignity.

Always

Often

Sometimes

Rarely

Never

Does not apply

If you answered "Sometimes", "Rarely" or "Never" to the previous question, please explain why you feel this way

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* 17. I feel that the employees at the Centre de santé communautaire de l’Estrie respect my differences (cultural, physical, intellectual, religious, sexual orientation, gender identity, etc.).

Always

Often

Sometimes

Rarely

Never

Does not apply

If you answered "Sometimes", "Rarely" or "Never" to the previous question, please explain why you feel this way

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* 18. I feel that the Centre de santé communautaire de l’Estrie respects my right to privacy and confidentiality.

Always

Often

Sometimes

Rarely

Never

Does not apply

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* 19. When I am at the Centre de santé communautaire de l’Estrie, I worry that other people may overhear my private conversations.

Always

Often

Sometimes

Rarely

Never

Does not apply

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* 20. I am confident that my personal health information is adequately protected.

Always

Often

Sometimes

Rarely

Never

Does not apply

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* 21. In general, when I arrive at the Centre de santé communautaire de l’Estrie for an appointment, someone comes to get me

Before my scheduled appointment

At the appointed time

Less than 10 minutes after my scheduled appointment

10-19 minutes after my scheduled appointment

20-29 minutes after my scheduled appointment

30 minutes or more after my schedules appointment

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* 22. I am satisfied with this wait time.

Always

Often

Sometimes

Rarely

Never

Does not apply

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* 23. I am pleased with the reception staff and with the way that I am greeted.

Always

Often

Sometimes

Rarely

Never

Does not apply

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* 24. I feel that the employees at the Centre de santé communautaire de l’Estrie are respectful and professional.

Always

Often

Sometimes

Rarely

Never

Does not apply

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* 25. I would refer a family member or a friend to the Centre de santé communautaire de l’Estrie.

Always

Often

Sometimes

Rarely

Never

Does not apply

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* 26. I have visited the Centre de santé communautaire de l’Estrie’s website in the past.

Always

Often

Sometimes

Rarely

Never

I was not aware the CSCE had a website

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* 27. I can easily find the information I am looking for on the Centre de santé communautaire de l’Estrie’s website.

Always

Often

Sometimes

Rarely

Never

Does not apply

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* 28. How can the Centre de santé communautaire de l’Estrie improve its services?

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* 29. In general, would you say your overall physical health is:

Excellent

Very good

Good

Fair

Poor

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* 30. How long have you been a client at the Centre de santé communautaire de l’Estrie?

Less than 6 months

6 - 12 months

1 - 2 years

3 - 4 years

5 - 10 years

More than 10 years

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* 31. Over the past year, how many times did you visit the Centre de santé communautaire de l’Estrie for your medical needs? (Please answer to the best of your knowledge.)

Once

Twice

Three times

Four times

Five times

More than five times

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* 32. Please indicate your age

12-17

18-24

25-34

35-49

50-64

65-75

75 and over

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* 33. Which of the following best describes your gender?

Female

Male

Intersex

Transgender - male to female

Transgender- female to male

Two spirit

I do not know

I prefer not answer

Other (please specify):

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* 34. What was your household’s TOTAL annual income last year?

Less than $15,000

$15,000- $30,000

$30,000- $45,000

$45,000- $60,000

$60,000-$75,000

$75,000-$100,000

More than $100,000

I prefer not to answer

Thank you!

We are thinking of organizing community forums and inviting clients to share what they like about the programs and services offered at the Centre de santé communautaire de l’Estrie, what can be improved and how we can better serve you.

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* 35. IF YOU PREFER YOUR ANSWERS TO REMAIN ANONYMOUS, YOU MAY CHOOSE NOT TO SHARE YOUR CONTACT INFORMATION BELOW.

Name

Telephone