Post therapy evaluation survey

Follow up survey

On requesting funding from Support4SDR Wales, you agreed to complete a questionnaire after your training or therapy so that we can collect information on outcomes and the progress made. This will help us to meet our success criteria as a charity and thus to apply for more funds on your behalf. Filling in this survey is a condition of future funding. All information on outcomes will be anonymous, although we will keep your personal details on record purely for the purposes of contacting you in relation of past or future funding.

Question Title

* 1. Contact details of person receiving the funding

Name

Email Address

Phone Number

Question Title

* 2. Please confirm which service provider you used

Question Title

* 3. On what dates did the funded sessions start and end

Start date

Date

End date

Date

Question Title

* 4. Did the therapy meet your expectations as provided in your funding request

Somewhat

Yes

Clear

i We adjusted the number you entered based on the slider’s scale.

Question Title

* 5. Please provide details of any benefits you have seen as a result of this therapy

Improved mobility

Improved flexibility

Improved stamina

Increased independence

improved state of mind (happiness)

Improved coordination

Improved balance

Improved concentration

Other (please specify)

Question Title

* 6. We would be grateful for any comments which highlights the benefits you have seen as a result of the therapy

Question Title

* 7. We would be grateful for any comments on the charity's process for funding or the work we carry out, in order to improve our services to members

Question Title

* 8. Would you be happy for us to use comments on our website anonymously, in order to highlight successes to other members of the charity?

Yes