Phoenix Wings Wellness- Have your say!
Please help us improve our services through valuable honest feedback
Name
First Name
Last Name
Gender
Male
Female
Prefer not to disclose
Other
If other please specify- please include preferred pronouns
Please indicate what communities you identify with
LGBTIQ+
Neurodivergent
Disability (Physical, intellectual, and/or mental)
Aboriginal/Torres Strait Islander
CaLD (Culturally and Linguistic Diverse)
Other
If other please specify
Agency
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
-
Area Code
Phone Number
What is main service of your agencies
What is your program and role
What demographics describe your clientele
Children
Adolescents
Adults
Homelessness
Family Violence
Disengaged from education
Unemployed
Disability
LGBTIQ+
Aboriginal Torres Strait Islander
CaLD community
Have you heard of Phoenix Wings Wellness?
Yes
No
Yes but never referred a client
No but want to refer a client
Do you know what services we offer- please tick all that apply
Individual counselling
Couples counselling
Family counselling
Group work
Support work
Other
If other please describe
What financial access would your clients have to utilise our service
Self funded
Agency funded
NDIS
Mental Health Care Plan
Other
If other please describe
Do you know how to make a referral?
Yes
No
Unsure
If you have had a client utilise a service, did you feel the service met your clients expectations
Not at all
1
2
3
4
5
6
7
8
9
Very much so
10
1 is Not at all, 10 is Very much so
Overall what areas improved for your client during their time with Phoenix Wings Wellness? (please tick all that apply to them)
Reduced anxiety
Reduced depression
More socially connected
Better access to community
Increased access to resources
Sense of belonging
More connected and aware of inner strengths/resources
Exploring and understanding your values
Increased awareness of my child/spouse/family
More control over my emotions/reactions
Increased self care
Better daily routines
Living skills (budgeting, social skills, utilising public resources such as public transport etc)
Ability to be myself authentically
Can identify with my spiritual or cultural beliefs
Permission to exercise my religion without judgement
Ability to use preferred pronouns/gender identity
Accepted and supported to access services regardless of my disability
Other
If other please describe
Please indicate the options that applied to your clients experience
I felt safe
I felt heard
I was able to use my voice
I was able to make my own decisions
I felt respected
I felt included
I felt accepted for who I am
I felt i could express my opinions and needs
Other
What other services or programs would you like to see Phoenix Wings offer? Please be specific.
How likely are you to refer a client, family member or friend?
Not at all
1
2
3
4
5
6
7
8
9
Very much so
10
1 is Not at all, 10 is Very much so
Where did you hear about us
Website
Facebook
Instagram
Other community health service
GP or medical professional referred
Family/friends
Word of mouth
Other
If other please specify
Please provide us any general comments or feedback that is important to you or your clients
Thank you for your feedback
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