Home visit | Let's Talk Horizon

Date of your appointment (day-month-year):

* required

Maximum 10 characters

0/10

Which Horizon facility provided your service (whether in person, by phone, or at home)?

* required

Select option

Under the Official Languages Act, you have the right to be served in either English or French. What is the official language of your choice?

* required

English

French

When meeting staff for the first time, did they greet you in both official languages by saying “Hello / Bonjour”?

* required

Yes

I don't remember

Did your appointment start on time?

* required

Yes, I was seen on time or earlier

No, I waited 15 minutes or less

I waited 16-30 minutes

Not Applicable

Other (please specify)

For each of the following statements, please indicate the extent to which you agree or disagree:

I was treated with courtesy and respect

* required

Agree

Disagree

I don’t remember

I was explained things in a way I could understand

* required

Agree

Disagree

I don’t remember

I was listened to carefully

* required

Agree

Disagree

I don’t remember

I was involved as much as I wanted to be in decisions about my or my child's care

* required

Agree

Disagree

Not applicable

10.

I received helpful information and education

* required

Agree

Disagree

I don’t remember

11.

I had enough time to ask questions

* required

Agree

Disagree

I don’t remember

12.

My privacy and confidentiality was maintained and respected during my appointment

* required

Agree

Disagree

I don’t remember

13.

It was easy for me to find and access this service

* required

Agree

Disagree

Not applicable

Please answer the following questions about your home visit with Public Health:

14.

What Public Health staff visited your home?

* required

Nurse

Dietitian

15.

Do you feel home visits are helpful?

* required

Yes

16.

Were you satisfied with the options available for your appointment with Public Health (at home, virtual, telephone, in-office)?

* required

Yes

17.

Was the Public Health staff visiting your home reliable?

* required

Yes

18.

Using a 0–10 scale, where 0 is the worst and 10 is the best, how would you rate the service or care you received?

* required

Select option

19.

Is there anything else you would like to share about your appointment with public health — what went well or what could be improved?

Maximum 255 characters

0/255