Give Feedback on care

1
Find the service, department or team you want to tell me about?* This field is required.
Alston House Residential Home
Enderby Grange
George Hythe House Residential Home
Gokul Vrandavan Residential Home
Long Lea Residential Home
Parkhouse Grange
Portland House Residential Home
The Magnolia Residential Home
The New Wycliffe Home
West View Residential Home
Whetstone Grange
Holmfield Day Centre
Quality Assurance Team (QAT)
Maintenance Team
The Head Office Team
Accounts / Finance or Payroll
2
What kind of experience do you want to tell me about?* This field is required.
Good
Bad
Both Good and Bad
3
Give me your feedback about {findThe}* This field is required.Try to give clear examples of what they did well. This information will be shared with the service, department, team or individuals when appropriate.
4
Which part of the service are you telling me about?* This field is required.For example, if it's one of our care homes, be as exact as you can about which room, floor or part of the home. If this is about a department or individual then please make this clear.
5
When did this happen?* This field is required.Give exact dates if you can - or tell me which month or year it was, or if it's still happening now.
E.g. 25th April or day shifts, night shifts etc.
6
Have you worked for {findThe}?* This field is required.This includes if you were a contractor or a volunteer. It also includes if you work there now.
YESNO
7
Can I contact you?* This field is required.
YESNO
8
Your Full Name* This field is required.
First Name
Last Name
9
Your Mobile Number* This field is required.
10
Email AddressThis is optional.
example@example.com
11
Would you prefer to remain anonymous?* This field is required.
Yes
No
12
Give me your feedback about {findThe}* This field is required.The more detail you give, the better. It helps me if you can tell me what was bad and anyone that was involved.
13
Have you told {findThe} about this? (Good or bad)* This field is required.All my services, departments and teams have a procedure for making formal complaints. If you make a complaint they should look into it and send you a response. They would also like to have positive feedback.
YESNO
14
Complete and Submit* This field is required.To complete the form, please answer the following question. This step helps prevent automated submissions and spam.
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