The mission of the Centre de santé et de services sociaux de Papineau is to provide high quality services to the population.

By filling out this questionnaire you will help us achieve our primary objective, which is to offer you high quality services.

Special attention will be given to your suggestions, which will undoubtedly help us to constantly improve the services we dispense to the population of our territory.

You can be assured that all information collected will be kept strictly confidential.

Ginette Gingras Delorme,
Deputy Executive Director

Our commitment: to make service quality our priority at all times

That is why your opinion is so important to us.

THANKS!

There are two options available to you to fill out this questionnaire.

Option 1 - Online form

You must enter all the information below. When you have completed the form press send button.

* Required field

1. SPECIFY THE LOCATION OF SERVICES OR VISIT: *

C.L.S.C.

Petite-Nation
Vallée-de-la-Lièvre
Val-des-Bois

Hospital

Hôpital de Papineau

Nursing home

Hospital Nursing Home
Petite-Nation
Vallée-de-la-Lièvre

2. TYPE OF SERVICES RECEIVED OR USED:

3. YOU USED OUR SERVICES AS A: *

user visitor person accompanying a user

4. DATE AND TIME OF VISIT: *

5. YOUR ASSESSMENT:

We would now like to know your level of agreement with the following statements after your
experience with the CSSS de Papineau:

	Fully agree	Somewhat agree	Somewhat disagree	Completely disagree	Not applicable	Do not know
Relational Sector This sector concerns the relationship between the personnel and the user. This relationship should be marked by humanism and based on respect for the individual and his/her rights.
You were treated with politeness and respect.
Your living habits were taken into account.
Your personal information was treated with confidentiality.
Your physical privacy was respected.
The professional you saw listened to you attentively and fully understood your situation (physician, nurse, social worker or other professional).

	Fully agree	Somewhat agree	Somewhat disagree	Completely disagree	Not applicable	Do not know
Professional Sector This sector, which concerns the professional aspect of service provision, refers to a profession, skill, or very specific way of meeting basic needs by appropriate attitudes, care, services and advice.
Your appointment times were kept punctually (dates and times of appointments).
Equipment was adapted to your needs.
Promises made to you were kept.
The different treatment or intervention options available were presented and explained to you.
You were encouraged to participate actively in all decisions concerning you.
The professional you saw took the time to clearly explain what was happening at each stage of the treatment or intervention (physician, nurse, social worker or other professional).
The professional you saw established an atmosphere of security and trust (physician, nurse, social worker or other professional).
You were encouraged to seek assistance or support from the people in your entourage (family, relatives, etc.), or your community resources.
The people who assist you were offered support.

	Fully agree	Somewhat agree	Somewhat disagree	Completely disagree	Not applicable	Do not know
Organizational Sector This sector, which concerns the organization of services, refers to the environment or context. The context may be more or less facilitating and comfortable, services may be more or less accessible and the systems, policies and procedures may ensure rapidity and continuity, or not.
You were spoken to in words you could easily understand.
The documentation you were given was easy to understand.
The procedures for making a complaint or expressing your dissatisfaction were easy to follow.
Whenever possible, it was the same professional who took care of you each time (physician, nurse, social worker or other professional).
It was easy to be referred for specialized services when necessary.
Your record was transferred to other institutions, organizations or professionals, when required.
The institution is easily accessible (including adapted transportation), or it is easy to park close by.
You received services adapted to your culture and language.
The institution was open at times that suited you (i.e. weekdays, weekend and/or evening).
The wait time for an appointment with professionals was reasonable.
When you did not have an appointment, the wait time was reasonable.
The wait time for the results of your examinations or assessments was reasonable.
The wait time for diagnostic services was reasonable (blood tests, scans, x-rays, etc.).
Equipment and rooms were clean.
The building and surroundings were safe.
The furniture was comfortable.

6. OTHER COMMENTS:

7. Name (optional):

Option 2 - Print version

We enable you to download a PDF version, then print it, complete it and send it by mail or by fax. Click on the link below to get printable version.

Questionnaire on service quality

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