Patient Survey Dilico Family Health Team Patient Survey Patient 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 services did you receive? * Diabetes Care Diabetes Education Social Support Foot Care Wound Care 2. How many years have you been a client/patient of the team? * Less than 1 year 2-5 years 6-10 years More than 10 years If you are human, leave this field blank. Next
