Siksika Health Services – Palliative Care Survey

Siksika Health & Wellness Centre

Siksika Health Services is looking for your input and knowledge about our palliative care services.

Please fill out the questions below to the best of your abilities, as well refer anyone you may know who can also fill our the answers below.

Palliative Care Survey

Community Survey looking to pull information and gauge interest to create a better response in our palliative care options.
Name
Have you or a family member accessed palliative care?
In which of the following settings did you or a family member receive services? (Check all that apply)
My cultural needs were considered. (e.g. individuals’ own beliefs, customs, social standards, traditions or religious beliefs)
Staff were compassionate and my or my family member was treated with respect
I had the necessary information needed to make good decisions about my health.
Staff talked to me about my health care options (e.g. procedures/tests/treatments)
Staff involved me or my family/support system in making decisions about my care.
My or my family member were comfortable expressing concerns relating to care.
Please check all that apply: