HCC & CPSS Survey Home and Community Care & Community and Personal Support Satisfaction Survey HCC & CPSS 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 What community did you receive services in? * 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) * Care Management Visiting Nursing Nutrition Physiotherapy Occupational Therapy Social Work Speech / Language Adult Life Enrichment Personal Care Homemaking Respite Foot Care Care Management * Very Poor Poor Fair Good Very Good Visiting Nursing * Very Poor Poor Fair Good Very Good Nutrition * Very Poor Poor Fair Good Very Good Physiotherapy * Very Poor Poor Fair Good Very Good Occupational Therapy * Very Poor Poor Fair Good Very Good Social Work * Very Poor Poor Fair Good Very Good Speech / Language * Very Poor Poor Fair Good Very Good Adult Life Enrichment * Very Poor Poor Fair Good Very Good Personal Care * Very Poor Poor Fair Good Very Good Homemaking * Very Poor Poor Fair Good Very Good Respite * Very Poor Poor Fair Good Very Good Wound Care * Very Poor Poor Fair Good Very Good Foot Care provided by: * VON Dilico Community Health Nurse Dilico Diabetes Nurse Dilico Care Manager Dilico Community and Personal Support Worker Comments If you are human, leave this field blank. Next
