Online Survey Information and Consent for Patients and/or their Families

You are invited to take this survey called Understanding Patient Reported Outcome Measures in Swift Current. The survey was created by the Swift Current Primary Health Care team in the Saskatchewan Health Authority (SHA).

Please take time to read this information carefully and discuss it with your family, friends and health providers.

Why is the survey being done?

The survey asks questions about your current health-related quality of life,  Your answers will help us to look at ways to improve our program and services. We encourage you to discuss the survey with your family, friends and health care team. If you have completed this survey within the last six months, we ask that you wait before completing it again.

What does the survey involve?

You can choose to complete this survey, or not. Your decision will not impact the health care you receive from the clinic in any way. The online survey has 17 questions and will take about 5-10 minutes to complete. You can stop the survey at any time. Once we receive your completed survey, your answers cannot be removed. You will not be compensated for participating in this initiative.

Are there risks and benefits to participating?

We don't know of, or expect, any risks to you by answering this survey. If you feel any discomfort answering the questions, you can stop the survey. The SHA provides resources for mental health that can be accessed at: MHAS - About Us ( Your answers are important and may benefit other patient and families in this program. They will help to show whether our current improvement projects are improving care for both you and other patients and families.

How will my privacy be protected?

All team members in the SHA must respect the privacy of patients, clients and residents we serve. In Saskatchewan, the Health Information Protection Act (HIPA) defines how the privacy of your personal health information must be maintained. Your confidentiality will be respected.

How will my data be collected, stored and shared?

Your data will be collected and stored by the SHA in a secure online system called REDCap. Only team members leading program improvements will have access to your data; however aggregate information may be shared via a clinic newsletter. Any information shared will be unidentifiable. Your data will be stored for a minimum of 5 years before it is deleted from our system. Results will be shared through reports, meetings, clinic newsletters and presentations. Results will not be used for purposes beyond program improvement and results will not be published in scientific journals.

Who do I contact for more information or if I have questions?

Please contact Curtis Newton at  

This study has been reviewed and approved on ethical grounds by the Research Ethics Board (REB) of the Saskatchewan Health Authority (SHA). If you have any questions or concerns about your rights as a research participant, you may contact the Chair of the Research Ethics Board at (306) 655-6822 or email concerns to Out of town participants may call collect.

Confirm you have read the above information and agree to participate in the survey.

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You have selected an option that triggers this survey to end right now.
To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.