Made-Well's Leavers Form

MADE-WELL

A Community Interest Company
Feedback Form for Leavers & Taster Day Visitors
Thank you for taking the time to complete this form. Your feedback helps us improve the services and support we offer. If you'd like to speak to someone directly, please contact us at staff@made-well.co.uk.
1 Full Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3. Are you completing this form because you are:

Leaving Made-Well CICAttended a free taster day but decided not to join
4. What was the reason for your decision to leave or not to continue with us?

Found alternative supportTravel or distance issuesChange in personal or family circumstancesFinancial reasonsNot the right fit for current needsWaiting list is too longHealth reasonsDidn't enjoy the visit/taster dayOther
5. Would you be happy to share any further feedback on your experience with Made-Well? What you enjoyed, what could be improved, or anything else you'd like us to know:
6. Would you consider returning to Made-Well in the future if your circumstances changed?

YesNoNot sure
7. How did you first hear about Made-Well?

Friend or familySocial mediaSchool or professional referralWebsiteEvent or open dayOther
8. Is there anything else you would like to tell us?
If you would like us to follow up with you, please let us know the best way to contact you:
Phone

Area CodePhone Number
Email
example@example.com
No follow-up needed
Thank you for your time and honesty. Made-Well CIC.

Email: staff@made-well.co.uk Website: www.made-well.co.uk

Tel: 01837 810584

Company Number: 06386837

Registered Office: Made-Well, West Fishleigh Farm, Hatherleigh, Okehampton, Devon, EX20 3QA. A Community Interest Company limited by guarantee.
Should be Empty:

MADE-WELL

Feedback Form for Leavers & Taster Day Visitors