- CMHA Cochrane-Timiskaming

French Language Services Experience Survey

French Language Services Experience Survey

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Further Discussions (Optional)

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The purpose of this survey is to inform the Canadian Mental Health Association Cochrane-Timiskaming Branch (CMHA-CT) regarding your experience as a client or caregiver with respect to services received in French. We would like to learn more about how you felt to improve the French language services offered to patients.

Which site did you receive services at?(Required)

Which program(s) / service(s) did you receive? (Check all that apply)(Required)

Specify other:

In which language did you receive the following services?(Required)

How did you feel about the language used to provide care at each of the following points of contact?(Required)

Did the language used during your care allow you to:(Required)

What is CMHA-CT doing well in relation to the provision of services in French?(Required)

How could CMHA-CT improve its offer of services in French?(Required)

Rate your overall experience regarding our French-language services on the following scale:(Required)

If other, please explain:

If you would like to be contacted to discuss how CMHA-CT can further improve French language services, please enter your contact information below.

Name

First Last

Phone

	French	English	French and English
Reception
Intake
Healthcare Services
Other services

	Yes	Most of the time	A little bit	Not really	Not at all
Understand well
Be well understood

Indifferent

Disappointed

Frustrated

Healthcare Services (Primary Care)

Other services