Patient Accessibility Survey

Please take a few moments to provide NGH with feedback on the accessibility of our facilities to persons with disabilities. Your feedback will help us to identify, prevent and remove barriers to persons with disabilities in accordance with the Ontarians with Disabilities Act, 2001. We take feedback into serious consideration and especially welcome suggestions for improvement.

Generated with MOOJ Proforms
* Required information.

Please assist us by answering the following questions.

1. Have you, or someone you know, experienced difficulty in accessing programs or services at NGH because of a lack of accommodation for persons with disabilities?
Please select: *
Yes
No
If yes, please describe the barrier that you or someone you know faced at the time of visit and offer suggestions for improvement.

2. Have you, or has someone you know, experienced difficulty in communicating with hospital personnel because of a disability while receiving hospital services?
Please select: *
Yes
No
If yes, please describe in detail and offer suggestions for improvement

3. Have you or has someone you know experienced an attitudinal barrier toward a person with a disability while at Norfolk General Hospital?
Please select: *
Yes
No
If yes, please describe in detail and offer suggestions for improvement
4. Please describe any other measures that Norfolk General Hospital could take to accommodate persons with a specific disability.
Respondent Type: *
Patient
Community Member
Staff

The information gathered through this survey is considered in the development of NGH’s Annual Accessibility Plan and by the programs and services mentioned in the feedback provided. Please note that NGH has a separate process through which you can seek to resolve concerns.

If we may contact you to clarify any of the information you have provided in this survey, please enter your name and e-mail address below:
Name:
Email:
Phone:

Thank you for your input!