Diabetes Survey Diabetes & Chronic Disease Management Satisfaction Survey Diabetes Survey 0% Complete1 of 3 I understand my answers will be confidential and all information collected will be used to make recommendations to Dilico Health Services. * Yes No 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. * Yes No Do not wish to answer 1. What community did you receive services in? * Please select one: * Home Visit Clinic Visit 2. How long have you been a client/patient of the program? * Less than 6 months 6 - 12 months 1 - 2 years 3 or more years 3. What service(s) did you receive during your visit and how would you rate the service(s)? (Please check service(s) and rating) * Diabetes Care Diabetes Education Social Support Foot Care Wound Care Diabetes Care * Very Poor Poor Fair Good Very Good Diabetes Education * Very Poor Poor Fair Good Very Good Social Support * Very Poor Poor Fair Good Very Good Foot Care * Very Poor Poor Fair Good Very Good Wound Care * Very Poor Poor Fair Good Very Good Comments 4. Overall, how would you rate the quality of care received? * Very Poor Poor Fair Good Very Good If you are human, leave this field blank. Next