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Bereavement survey

If you are looking to complete the complex medical needs survey, please click here.

Your perspectives and insights about the experience with your child are important. These will guide us towards meaningful enhancements to the services we provide to children and their families. Thank you for taking the time to fill out this survey.

1.  

What was the age of your child at the time of their death?

* required

Maximum 255 characters

0/255

3.  

Where did the death of your child happen?

* required
4.  

Does your child have siblings?

* required
5.  

Please tell us how much you agree or disagree with the following statements:

* required
I was involved as much as I wanted to be in the communication and decisions about my child’s care and treatment
My child’s health care team explained things so I could understand what was happening to my child.
The health care team did enough to manage my child’s end of life symptoms to ensure their comfort (pain, nausea, shortness of breath, etc)
6.  

Were the cultural needs of your family met?

* required
7.  

Did you (or do you) have access to counselling (spiritual care, social work, psychology)?

* required
8.  

Did you or a family member receive a bereavement package from Horizon?

* required

Maximum 20,000 characters

0/20,000

10.  

To continually improve our services to our patients and their families, would you be willing to be contacted by a Horizon staff member to discuss your experience?

* required