Feedback Form
An opportunity to provide Essential Life Skills with feedback on the service you have received. Thank you for completed this form. The information on this form will help to monitor service quality and make improvements where necessary.
Gender
Please Select
Female
Male
Transgender
Non Binary
Prefer not to say
Other
Age group
Please Select
18 - 25
26 -35
36 - 45
46 - 55
56 - 65
66 - 75
76 - 85
86+
Do you consider yourself to have a disability
Please Select
Yes - prefer not to provide more details
Yes - Mental Health
Yes - Autistic Spectrum Condition
Yes - Learning Disability
Yes - Physical
Yes - Sensory
No
I prefer not to say
Do you access any support from any of the following services (now or in the last 6 months)
Please Select
GP
Psychiatrist
Community Psychiatric Nurse
Social Worker
Psychologist
Occupational Therapist
Nutritionist
Counsellor
Charity providing mental health support
Charity providing other support
College/University Support Services
Carer
Cleaning service
Meal preparation service (e.g. meals on wheels)
Personal Assistant
Transport service (e.g. regular taxis or specialist transport service)
Other
If you ticked other, you can provide more information here.
What kind of support did Essential Life Skills provide you with?
Please Select
Face to face 1:1 support
Virtual (online) support
Attended social group
Attended group training
Signposting to other sources of support
Information only
Other
If you ticked other, you can provide more information here.
How many sessions did you access?
Please Select
1
2 - 5
6 - 10
11 - 15
16 - 20
More than 20
Ongoing group
Other
What area of your life did Essential Life support you with?
Please Select
Budgeting skills
Decluttering
Organising paperwork
Skills to help me manage my own mental health
Emotional Support during a difficult time
Support using public transport
Support to take better care of my home environment
Support to develop a healthier daily routine
Improving self confidence and assertiveness
Support accessing technology
Other
If you ticked other, you can provide more information here.
How helpful was this support?
Please Select
It helped a lot
It helped a bit
It helped a little
It didn't help
It made my situation worse
What was helpful/unhelpful?
Would you recommend this service to a friend or family member?
Please Select
Yes
No
Rather not say
How did you hear about this service?
Please Select
Facebook
Twitter
Meet up
Herts Direct
Community First
A friend or family member told me about it
Website
Other
Would you consent for Essential Life Skills using an anonymous quote from this form on their website?
Please Select
Yes
No
Any other comments?
Submit
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