Caregiver Experience Survey

Your feedback is important to us!


CMHA Waterloo Wellington is committed to providing the highest quality of care to our clients. To help us achieve this, we kindly ask that you take 3-5 minutes of your time to complete our client experience survey. Your feedback is greatly appreciated and will provide valuable insight into the quality of our services and how we can improve them to best support our clients.


Completing the survey is entirely your choice and you can skip any questions you do not wish to answer. Your answers are 100% anonymous and confidential and cannot be linked to you in any way.


Thank you!

CMHA Waterloo Wellington

Are you answering this survey as a Client or Caregiver?
Which site does your loved one primarily receive services from?*
Which service/program does your loved one primarily attend?*
Which service/program does your loved one primarily attend?*
Which service/program does your loved one primarily attend?*
Which service/program does your loved one primarily attend*
Which service/program does your loved one primarily attend?*
Which service/program does your loved one primarily attend?*
Which service/program does your loved one primarily attend?*
Which service/program does your loved one primarily attend?*

Please answer the following questions based on your experience with the service/program you listed in the previous question (above).

1. I felt I was a valued member of the care team for my loved one.
2. If I had a serious concern, I would know how to make a formal complaint to this organization.
3. Staff provided me with adequate, easily understandable information (i.e. diagnosis, prognosis, symptoms, health status, progress, treatment plan, medication) about my loved one's challenges.
4. When my loved one first began receiving treatment, they were encouraged by staff to give consent for me to be involved in their care.
5. I think the services provided here are of high quality.

The following questions ask for some details about you in order to help organize the information for quality improvement purposes (for example, ensuring services are non-discriminating). You may answer only the questions that you feel comfortable answering, and you may stop at any time.

What is your age?
What is your gender?
Which of the following best describes your racial or ethnic group?
How far along is your loved one in the treatment services and support process?

Thank you for your participation!

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