Feedback Form

Little Petal Feedback Form
Feedback from the people we support and interact with is imperative to us and our understanding about areas we need to improve and develop upon to ensure that we continue to provide high quality services.

Any feedback provided on this form will be treated with the strictest confidentiality and used for the purpose of continually improving Little Petal services.

From time to time we ask our clients for permission to share their feedback on Little Petal's social media platforms, and/or website. When we do this we make sure not to share information that can easily identify them or where they live, for example, we may just use initials or first name's only.
Date

DayMonthYear
Date
Choose one
Specify here
Name

First NameLast Name
Phone Number
Email
example@example.com
How long have you been engaged with Little Petal?
How did you hear about Little Petal?
Psychologist, on Facebook etc.
Type of input
How does Little Petal currently assist you (and your family - if applicable)?
Details of Feedback / Compliment / Complaint
How would you rate communication with Little Petal (1 being poor-10 being excellent).

1

2

3

4

5

6

7

8

9

10

1 is Poor, 10 is Excellent
Please explain why you chose your score.
Do you have anything else you would like to include in your feedback?
Thank you for taking the time to complete this feedback form.
Your contribution allows us to understand where we can improve our services. Little Petal may contact you to discuss your feedback to ensure that we have entirely captured the important information you have shared with us.
Should be Empty:

Little Petal Feedback Form