H&CC Survey

At Dilico Health Services, we depend on your comments and suggestions to help us better meet our client needs and make improvements based on your feedback. All responses will be kept confidential unless you choose to provide your name.

1. Are you completing this survey for yourself or someone else? (please check)

If Someone Else, please specify:

2. How long have you been receiving Home & Community Care Services?

3. What types of services are you receiving and how would you rate the quality of care? (please check service AND rating)

* Foot Care provided by:

Please feel free to elaborate on services in the "Comments" box.

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

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

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

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

8. Did staff provide you and your family or caregiver with emotional support and counselling?

9. Were you treated with dignity and respect?

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

If YES, please enter your contact information below: