HC-428

PSYCHOLOGY SERVICES
P.O. BOX 2415
EDMONTON, AB T5J 2S5
Worker Satisfaction Survey
FAX: (780) 427-5863
1-800-661-1993

Your feedback via this survey will help Workers’ Compensation Board (WCB) Health Care Services to improve services
for all WCB workers. We consider your opinion to be very important in the development and maintenance of high quality
rehabilitative care for WCB clients. All responses are confidential and will not affect your claim in any way. Please return
the completed survey in the stamped, self-addressed envelope provided.
The personal information on this form is being collected in compliance with section 33(c) of the Freedom of Information
and Protection (FOIP) Act, and will be used for the purpose of quality assurance. The information will be treated in
accordance with the privacy protection provisions of Part 2 of the FOIP Act. If you have any questions about the collection
please contact: Program Evaluation Team of the WCB Health Care Services Department (780) 498-3219 or write to:
Health Care Services, Millard Health, 131 Airport Road, Edmonton, AB T5G 0W6.

Provider Name: Date:

Place an X in the box of your choice for each question to indicate the degree to which you agree with the
following statements.
Strongly Strongly
Questions: Disagree Disagree Agree Agree

My overall experience with this counselling provider was satisfactory.

I found this counselling provider easy to talk to.
This counselling provider understood my problems.
I found this counselling provider knowledgeable and competent.
The counselling provider and I worked together to develop treatment
goals.
The counselling helped me get better.
The counselling provider provided me with information to read,
“homework” and practice activities between sessions that were helpful.
I learned to look at my situation from different points of view, and feel
that my attitudes and beliefs have changed as a result of counselling.
I have more information and a better understanding of factors that
contributed to my difficulties.
My presenting problems were adequately addressed.
The counselling helped me go on with my life.
As a result of my counselling, I feel better and am experiencing fewer
difficulties.
I was able to get an appointment within a reasonable period of time.
The counselling provider was punctual in keeping appointments.
I would recommend this c to a friend with similar difficulties.
Additional Comments:

HC – 428 REV DEC 2018 Page 1 of 1