Immunization | 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)?

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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 the following statement, please indicate the extent to which you agree or disagree:

I was treated with courtesy and respect.

Agree

Disagree

I don't remember

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

* required

I was explained things in a way I could understand.

Agree

Disagree

I don't remember

Not applicable

I was listened to carefully.

Agree

Disagree

I don't remember

Not applicable

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

Agree

Disagree

I don't remember

Not applicable

I received helpful information and education.

Agree

Disagree

I don't remember

Not applicable

I had enough time to ask questions.

Agree

Disagree

I don't remember

Not applicable

My privacy and confidentiality was maintained and respected during my appointment.

Agree

Disagree

I don't remember

Not applicable

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

It was easy for me to find and access this service

* required

Agree

Disagree

Not applicable

The environment was comfortable, inviting, and judgement-free

* required

Agree

Disagree

Not applicable

At your most recent immunization appointment with Public Health:

10.

Before vaccination, did staff confirm your name or your child's name?

* required

Yes

I don't remember

11.

Before vaccination, did staff confirm your date of birth or your child’s date of birth?

* required

Yes

I don't remember

12.

Before vaccination, did staff offer your child a comfort aid?

Ex: Buzzy Bee, cold gel pack

* required

Yes

I don't remember

13.

Before vaccination, did staff clean their hands using hand sanitizer or soap and water?

* required

Yes

I don't remember

14.

Did staff provide enough support to help with fears or worries related to vaccination?

* required

Yes

Not applicable

15.

Did staff provide enough information about possible vaccine side effects?

* required

Yes

Not applicable

16.

If breastfeeding, did staff encourage you to breastfeed during your appointment?

* required

Yes

Not applicable

17.

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

18.

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

Maximum 500 characters

0/500