You must have JavaScript enabled to use this form. Zone * - Select -Moncton (Dr. Georges-L.-Dumont UHC)Saint-Anne-de-Kent (SMK Hospital)EdmundstonGrand-SaultSaint-QuentinCampbelltonBathurstCaraquetTracadieLamèque Date * Vitalité Health Network is committed to providing the best possible health care. To better serve our patients and better understand their needs, we would like your feedback on the services your loved one received. Your answers will remain confidential and your feedback will help us improve our services. Think about the care provided to your loved one and the support services you received. For each question, please check the box that best reflects your level of satisfaction. 1) Your loved one’s level of comfort * Very good Good Fair Poor Not applicable 2) Respect for your loved one’s dignity * Very good Good Fair Poor Not applicable 3) Speed at which your loved one’s physical, emotional, social or spiritual problems were identified and treated * Very good Good Fair Poor Not applicable 4) The way in which we met your loved one’s comfort needs and provided concrete assistance (e.g. bath, care) to them * Very good Good Fair Poor Not applicable 5) Availability of staff for your loved one and your family * Very good Good Fair Poor Not applicable 6) Emotional support provided to your loved one and your family * Very good Good Fair Poor Not applicable 7) Information given to you on how you could help manage your loved one’s symptoms (e.g. pain, constipation) * Very good Good Fair Poor Not applicable 8) Response of the care team to the changing care needs of your loved one * Very good Good Fair Poor Not applicable 9) Were you and your family informed about grief support groups in the community? * Yes No Not applicable 10) Were you and your family informed about the employment insurance program for family caregivers? * Yes No Not applicable 11) Overall, how was your experience in palliative care? * 0 1 2 3 4 5 6 7 8 9 10 0 being the worst experience and 10 being the best experience 12) How often did the staff explain things (e.g. your loved one’s health status, treatments administered, progress achieved) in a way that you could understand? * Always Usually Sometimes Never 13) Did you and your family participate as much as you wished in decisions regarding your loved one’s care and treatment? * Always Usually Sometimes Never Comments If you have any questions and you would like us to get in touch with you, please provide us with your contact information. Name Telephone Leave this field blank