{"id":15741,"date":"2016-12-16T14:21:54","date_gmt":"2016-12-16T19:21:54","guid":{"rendered":"http:\/\/52.229.127.56\/?page_id=15741\/"},"modified":"2025-11-06T10:12:08","modified_gmt":"2025-11-06T15:12:08","slug":"feedback-form","status":"publish","type":"page","link":"https:\/\/www.ottawahospital.on.ca\/en\/patients-visitors\/accessibility\/feedback-form\/","title":{"rendered":"Feedback Form"},"content":{"rendered":"<p>Patients can submit their feedback electronically using the forms below. If you would like a copy of your submission for your files, <strong>before you click on \u201cSubmit\u201d<\/strong> we suggest you do one of the following:<\/p>\n<ul>\n<li>Print the page<\/li>\n<li>Copy and paste your text into a Word document<\/li>\n<\/ul>\n<h2>Feedback Form<\/h2>\n<p><strong>We are working to improve accessibility at The Ottawa Hospital.<\/strong><\/p>\n<p>Your feedback is important to us! Please help us continue to improve accessibility at The Ottawa Hospital and our partners so that we can better serve our patients with various disabilities (vision, hearing, mobility, dexterity, mental health, etc.)<\/p>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f27299-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"27299\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/15741#wpcf7-f27299-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"27299\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.4\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f27299-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_extcf7_conditional_options\" value=\"{&quot;form_id&quot;:27299,&quot;conditions&quot;:[]}\" \/><input type=\"hidden\" name=\"_extcf7_redirect_options\" value=\"{&quot;form_id&quot;:27299,&quot;redirect_options&quot;:{&quot;redirection_enable&quot;:&quot;off&quot;,&quot;custom_url_enable&quot;:&quot;off&quot;,&quot;redirect_page&quot;:&quot;&quot;,&quot;custom_urle&quot;:&quot;&quot;,&quot;redirect_new_tab&quot;:&quot;off&quot;,&quot;js_action&quot;:&quot;off&quot;,&quot;javascript_code&quot;:&quot;&quot;}}\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<p><label for=\"dateandlocationofvisit\">1. Please tell us the date and location of your visit:<\/label>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"dateandlocationofvisit\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"dateandlocationofvisit\" aria-invalid=\"false\" name=\"dateandlocationofvisit\"><\/textarea><\/span>\n<\/p>\n<fieldset>\n\t<legend class=\"nomargin\"><strong>2. When accessing our goods and services, do you use:<\/strong>\n\t<\/legend>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-goodsandservicesaccessed\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-goodsandservicesaccessed[]\" value=\"a support person\" \/><span class=\"wpcf7-list-item-label\">a support person<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-goodsandservicesaccessed[]\" value=\"assistive devices (e.g. wheelchair, scooter, hearing aid, communication board, cane, etc.)\" \/><span class=\"wpcf7-list-item-label\">assistive devices (e.g. wheelchair, scooter, hearing aid, communication board, cane, etc.)<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-goodsandservicesaccessed[]\" value=\"a service animal\" \/><span class=\"wpcf7-list-item-label\">a service animal<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-goodsandservicesaccessed[]\" value=\"other(please specify)\" \/><span class=\"wpcf7-list-item-label\">other(please specify)<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n<\/fieldset>\n<p><label for=\"othergoodsandservices\"><span class=\"feedbacklabel\" style=\"display: block;\">Other goods and services<\/span><\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"othergoodsandservices\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text floatleft\" id=\"othergoodsandservices\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"othergoodsandservices\" \/><\/span>\n<\/p>\n<p><label class=\"margintop15\" for=\"difficultiesaccessinggoodsandservices\">3. What difficulties did you experience accessing our goods and services?<\/label>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"difficultiesaccessinggoodsandservices\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"difficultiesaccessinggoodsandservices\" aria-invalid=\"false\" name=\"difficultiesaccessinggoodsandservices\"><\/textarea><\/span>\n<\/p>\n<p><label for=\"accessibilitysuggestions\">4. What suggestions do you have to help us improve accessibility?<\/label>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"accessibilitysuggestions\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"accessibilitysuggestions\" aria-invalid=\"false\" name=\"accessibilitysuggestions\"><\/textarea><\/span>\n<\/p>\n<p><label for=\"nameandcontactdetails\">5. Name and contact details (optional):<\/label>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"nameandcontactdetails\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" id=\"nameandcontactdetails\" aria-invalid=\"false\" name=\"nameandcontactdetails\"><\/textarea><\/span>\n<\/p>\n<p><label class=\"margintop15\" for\"uploadinganimage\">6. If you would like to include one or two photos to help us better understand your concerns and address the accessibility barriers that need attention, please upload them. Please avoid including any people in the photo(s) to help us protect the privacy of patients and visitors. If you are including a photo of a form or any other type of document, please make sure it does not include any personal information such as a name or contact information.<\/label>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"file-40\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\"audio\/*,video\/*,image\/*\" aria-invalid=\"false\" type=\"file\" name=\"file-40\" \/><\/span>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"file-55\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\"audio\/*,video\/*,image\/*\" aria-invalid=\"false\" type=\"file\" name=\"file-55\" \/><\/span>\n<\/p>\n<p class=\"margintop15\"><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/><a target=\"_blank\" href=\"\/en\/patients-visitors\/privacy\/disclaimer-privacy-statement\/\">Privacy Policy<\/a>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n<div class=\"contact-text-inner toh-blue\">\n<p class=\"contact-text\"><strong>Do you need information in another format?<\/strong><br \/>If you have a disability and would like information in a different format, please ask us. We will work with you to create the format that\u2019s best for you. We are happy to support the Accessibility for Ontarians with Disabilities Act (2005). Please send your request to <a href=\"mailto:accessibility@toh.ca\">accessibility@toh.ca<\/a> or call 613-737-8899 extension 18680.<\/p>\n<\/div>\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Patients can submit their feedback electronically using the forms below. If you would like a copy of your submission for your files, before you click on \u201cSubmit\u201d we suggest you do one of the following: Print the page Copy and paste your text into a Word document Feedback Form We are working to improve accessibility [&hellip;]<\/p>\n","protected":false},"author":25,"featured_media":0,"parent":186,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_mc_calendar":[],"footnotes":""},"class_list":["post-15741","page","type-page","status-publish","hentry"],"acf":[],"wps_subtitle":"","_links":{"self":[{"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/pages\/15741","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/users\/25"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/comments?post=15741"}],"version-history":[{"count":0,"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/pages\/15741\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/pages\/186"}],"wp:attachment":[{"href":"https:\/\/www.ottawahospital.on.ca\/en\/wp-json\/wp\/v2\/media?parent=15741"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}