1.How old are you?

55-64 years old

65-74 years old

75-80 years old

81-85 years old

86-90 years old

91-95 years old

95 and over

2.What region of Quebec do you live in?

Bas-Saint-Laurent

Saguenay–Lac-Saint-Jean

Capitale-Nationale

Mauricie

Estrie

Montréal

Outaouais

Abitibi-Témiscamingue

Côte-Nord

Nord-du-Québec

Gaspésie–Îles-de-la-Madeleine

Laval

Laurentides 

Chaudière-appalaches

Lanaudière

Montérégie

Centre-du-Québec 

3.To what extent do you use the services available in your community to support your well-being?

Never

Rarely (less than 1 to 3 times a month)

Sometimes (1 to 3 times a month)

Often (3 times a month or more)

4.How would you rate the ease of access to obtaining health care and social services you need in English in Quebec ?

It's always difficult to access services

Some services are difficult to access

Most services are easily accessible

5.If you indicated in the previous question that some services are easier to access than others, which services are easier to access?

6.What challenges have you faced in accessing services available in your community to support your well-being?

Difficulty obtaining services in my language

Feeling that the person I meet doesn't understand my needs

Difficulty accessing services close to home

Feeling excluded

Other (please specify):

7.Have you ever felt stigmatized when seeking or receiving healthcare because of (mark all that apply):

Your age

Your language

Your physical disabilities

Your intellectual disabilities

Your mental health status

Your chronic/long term condition

Your ethnicity

Your gender

Your income/social status

Your religion

Your sexual orientation

No

Other (please specify)

8.In Quebec, a model has been created to support community actions that promote the health and well-being of English-speaking seniors. This modelassumes that the 5 priority needs of English-speaking seniors in Quebec are as follows: Health and social services; Health promotion and prevention; Home support and living arrangements; Reducing isolation and Caregiver support. 
Do these 5 priorities make sense to you? Why or why not?

Yes

No

I would have withdrawn "Health and social services"

I would have withdrawn "Health promotion and prevention"

I would have withdrawn "Home support and living arrangements

I would have withdrawn "Reducing isolation"

I would have withdrawn "Caregiver support"

I would have added "End of life support and care"

I would have added "Countering abuse"

Other (please specify)

9.If you could identify 3 priorities for action regarding your access to the services offered to you for your well-being, what would they be?

10.If you could identify 3 priorities for action regarding your sense of inclusion in the services offered to you, what would they be?