Complex Care Survey

Dilico Health Services depends on your feedback to ensure we meet the needs of all clients. We make improvements on program and service delivery based on your feedback. All responses are kept confidential.


Do you identify as Aboriginal? Aboriginal peoples are defined in the Canadian Constitution Act, 1982, Section 35 (2) as including First Nation, Inuit, and Metis peoples.








3. What service(s) did you receive during your visit and how would you rate the service(s)? (Please check service(s) and rating)

* Foot Care provided by:



4. How would you rate your health care provider on the following?


5. Overall, how would you rate the quality of care received?


6. Did you have enough say about the care you received?


7. Did staff explain your care and service to you?


8. Did staff tell you about other services and supports available in the community?


9. Did staff provide you and your family or caregiver with emotional support and counselling if applicable?






Would you like a follow-up phone call or follow-up visit regarding this survey?

If YES, please enter your contact information below:

Meegwetch/Thank you for taking the time to complete the survey, your feedback is greatly appreciated.