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ABORIGINAL HEALTH SERVICE SURVEY
1
Step 1
2
Step 2
3
Step 3
Health Service Used (Indicate which specific health service you accessed)
*
Clinic Visit
Dentist
Eye Check
Outreach Service
Staff Cultural Safety
*
Excellent
Good
Fair
Poor
How safe and respected did you feel by the staff?
Wait Time (Minutes)
*
Approximate wait time before seeing a healthcare worker.
Next: Step 2
Need for Transport
*
Yes
No
Was transport to or from the service difficult to arrange?
Communication Clarity
*
Clear
Unclear
Were the health instructions given to you easy to understand?
Privacy Concerns (Select any privacy concerns you experienced)
*
None
Crowded waiting area
Too many staff present
Private info shared
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Next: Step 3
Referred to Specialist
*
Yes
No
Were you referred to a specialist or other service?
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