Feedback Form
Completion of this form is voluntary. All information collected in this questionnaire is anonymous unless you choose to be contacted about your feedback. It would be helpful if you could answer all questions, but please leave any question blank if you do not want to answer it. Your responses are confidential, de-identified and will be treated in accordance with our privacy policy.
Feedback Type
Compliments
Complaints
General Feedback
How do you use our service?
Young person accessing a service
Family, Friend or Carer
Professional
Other
Would you recommend headspace Echuca to other people?
Agree
Disagree
Neutral
Were you able to get an appointment at a date/time that suited you?
Agree
Disagree
Neutral
Were headspace Echuca's facilities clean?
Agree
Disagree
Neutral
Do you feel welcomed at headspace Echuca?
Agree
Disagree
Neutral
Please write any other general feedback in the box below:
Would you like us to contact you about this feedback?
Yes
No
If you selected yes to being contacted, please provide the following details below and we will get back to you as soon as possible
Name
First Name
Last Name
E-mail
example@example.com
Phone number
If you would like to provide us with more feedback in another format, please feel free to come in and see us at 451 High Street Echuca, phone us on 5485 5048, or send us an email at headspace@erh.org.au.
Submit Feedback
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