Client Feedback Survey

Client Feedback Survey

ABN: 55 637 079 620
This survey is confidential. We would appreciate your feedback about our service, to assist us to make improvements in the way we provide assistance.
Participant Full Name (Optional)

First NameLast Name
Phone Number (Optional)
Email (Optional)
example@example.com
Please rate each of the following statements from 1 to 5
- 1 - Completely Disagree
- 2 - Somewhat disagree
- 3 - Neither agree or disagree
- 4 - Agree
- 5 - Strongly Agree
- N/A - If you feel the question is not applicable to you
- DK - If you do not have enough information or provide an answer

	1	2	3	4	5	N/A	DK
It was easy to find the service.
The information about the service matched my service delivery experience.
The wait time for service was reasonable.
The service provision is flexible and responsive.
The staff have high levels of skills and expertise.
The service actively involves my carer and other family members.
Service planning includes consideration of my language and cultural needs.
I am supported and encouraged to participate in my service planning.
I am encouraged and supported to be involved in the service's activities.
I have been supported to link in with other community organisations and services.
There are good feedback and complaints mechanisms in place.
We are clear when we give you information
You are happy with our service

What do you like most about Empowered Therapy and Training?*
What do you like least about Empowered Therapy and Training?*
What suggestions do you have about ways that we could improve our service/s?*
Any other comments:*
Would you like someone to contact you regarding the feedback you have provided on this survey?*

YesNo
Should be Empty:

Please rate each of the following statements from 1 to 5