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Your experience with AmeCare
(a survey to collect client feedback)
11
Questions
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1
What was your first impression of AmeCare?
Prompt: Did you like AmeCare's services when we first started supporting you?
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4
5
0 = Bad
5 = Good
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2
Think about the people from AmeCare that are supporting you - how do they make you feel?
Never
Rarely
Sometimes
Often
Always
I feel listened to and my concerns are taken seriously
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I feel valued and respected
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AmeCare employees have clear boundaries with me
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AmeCare employees are actively engaged and excited to work with me
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I am included in decisions about my care or the way I receive support
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I feel safe to express myself, my views, and my beliefs
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I have been bullied or degraded by someone from AmeCare
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I am clear on what AmeCare employees can and cannot do for me
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I know if or when AmeCare makes changes to my support plan
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I help create my goals
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I am consulted about my support plan
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I am happy with the level of care that AmeCare employees provide
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AmeCare wants to make sure I have positive experiences with their employees
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I like AmeCare's culture and what they represent as an organisation
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The support I receive suits my needs
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I will recommend AmeCare's services
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I feel listened to and my concerns are taken seriously
I feel valued and respected
AmeCare employees have clear boundaries with me
AmeCare employees are actively engaged and excited to work with me
I am included in decisions about my care or the way I receive support
I feel safe to express myself, my views, and my beliefs
I have been bullied or degraded by someone from AmeCare
I am clear on what AmeCare employees can and cannot do for me
I know if or when AmeCare makes changes to my support plan
I help create my goals
I am consulted about my support plan
I am happy with the level of care that AmeCare employees provide
AmeCare wants to make sure I have positive experiences with their employees
I like AmeCare's culture and what they represent as an organisation
The support I receive suits my needs
I will recommend AmeCare's services
Never
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Rarely
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Sometimes
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Often
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Always
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Never
Row 1, Column 0
Rarely
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Sometimes
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Often
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Always
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Never
Row 2, Column 0
Rarely
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Sometimes
Row 2, Column 2
Often
Row 2, Column 3
Always
Row 2, Column 4
Never
Row 3, Column 0
Rarely
Row 3, Column 1
Sometimes
Row 3, Column 2
Often
Row 3, Column 3
Always
Row 3, Column 4
Never
Row 4, Column 0
Rarely
Row 4, Column 1
Sometimes
Row 4, Column 2
Often
Row 4, Column 3
Always
Row 4, Column 4
Never
Row 5, Column 0
Rarely
Row 5, Column 1
Sometimes
Row 5, Column 2
Often
Row 5, Column 3
Always
Row 5, Column 4
Never
Row 6, Column 0
Rarely
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Sometimes
Row 6, Column 2
Often
Row 6, Column 3
Always
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Never
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Rarely
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Sometimes
Row 7, Column 2
Often
Row 7, Column 3
Always
Row 7, Column 4
Never
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Rarely
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Sometimes
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Often
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Always
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Never
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Rarely
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Sometimes
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Often
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Always
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Never
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Rarely
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Sometimes
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Often
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Always
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Never
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Rarely
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Sometimes
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Often
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Always
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Never
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Rarely
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Sometimes
Row 12, Column 2
Often
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Always
Row 12, Column 4
Never
Row 13, Column 0
Rarely
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Sometimes
Row 13, Column 2
Often
Row 13, Column 3
Always
Row 13, Column 4
Never
Row 14, Column 0
Rarely
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Sometimes
Row 14, Column 2
Often
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Always
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Never
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Rarely
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Sometimes
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Often
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Always
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3
Do you receive similar support from other services?
Prompt: Is there another agency providing support workers for you?
Yes
No
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4
How likely are you to replace the current services you use with another provider?
Prompt: Would you rather have support workers from AmeCare, or a different support agency?
0
1
2
3
4
5
0 = I want to stop my AmeCare supports
5 = I want to keep my AmeCare supports
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5
What are the top 3 things you like the most about AmeCare's services?
Prompt: What are 3 things you have enjoyed doing with AmeCare employees?
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6
What are the top 3 things that you would change or improve about AmeCare's services?
Prompt: What are 3 things that you wish were different about AmeCare's services?
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7
Thank you for taking the time to let us know your experiences. Is there anything else you would like us to know about?
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8
Do you wish to remain anonymous?
*
This field is required.
Yes
No
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9
Are you happy for us to contact you about your responses?
*
This field is required.
Yes
No
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10
Your Name
*
This field is required.
First Name
Last Name
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11
Your preferred contact details
*
This field is required.
Email
Phone
Your Contact Details
Row 0, Column 0
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Your Contact Details
Email
Row 0, Column 0
Phone
Row 0, Column 1
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