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| The purpose of this survey is to determine Métis Albertans' access to and quality of health care. The survey is anonymous and all information is kept confidential and used for research purposes only. |
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| Please tell us about yourself: |
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| 1. Are you a member of the Métis Nation of Alberta? |
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| 2. What community/town/city do you live in? Please specify your province if you do not live in Alberta. | | |
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| 3. Which category below includes your age? |
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| 5. Chronic diseases are defined as lasting longer than 3 months and requiring continuous treatment. Examples include high blood pressure, diabetes, asthma, arthritis etc. Do you have any chronic diseases? |
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| 6. Do you have a family doctor? |
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| 7. Please specify which health care provider you use most often and answer questions 8-14 about the care you receive from them. |
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| 8. How easy is it to get to your health care provider? |
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| 9. Overall, how well do you understand your health care provider’s explanations, instructions and questions? |
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| 10. How well does your health care provider listen to you? |
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| 11. How well respected do you feel by your health care provider? |
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| 12. How much do you trust your health care provider? |
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| 13. How often, if ever, have you received unsatisfactory care because of your race/ethnicity/language? |
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| 14. Overall, how satisfied or dissatisfied are you with the health care you receive? |
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| 15. From the following list, please select your greatest barrier(s) to accessing health care services (select all that apply). |
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| Family care clinics (FCC’s) are primary health care delivery organizations that provide a wide range of primary health care services that address patients’ health and social needs. Care is provided by a team of family physicians, registered nurses, dietitians, pharmacists, mental health professionals and others. |
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| 16. The MNA is currently developing a family care clinic located in Edmonton, AB that will focus on the health needs of the Métis population. At the clinic the following services and more will be offered. Keeping in mind that all the information in this survey will be kept confidential, please indicate ALL the services that you would be interested in accessing. |
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| 17. Please tell us what services, not listed above, that you would like to see at this clinic. |
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| 18. Do you think you will use this clinic, when it opens? |
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| 19. During which hours would you be most likely to access services at this clinic? |
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