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* 1. What ACTIVITIES do you attend? What SUPPORT do you receive from us? (You may tick more than one box.)

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* 2. Is this support SUFFICIENT and APPROPRIATE to your needs (including to help you have as much social contact as you want with people you like)?

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* 3. Does our support help you TO MAINTAIN YOUR INDEPENDENCE and ABILITY to live the life you want at home and in your community?

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* 4. Have you ever COMPLAINED about our activities or support?

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* 5. As a result of our support and planning, do you feel MORE SAFE, SECURE, INDEPENDENT AND BETTER ABLE TO LIVE AT HOME?

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* 6. Are our workers and volunteers RELIABLE? (For example, do they do what they say they are going to do, when they say they are going to do it?)

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* 7. Do we provide the support AGREED in your support plan?

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* 8. Do we LISTEN to you and ASK how you think our support and activities could be improved?

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* 9. Do we RESPECT YOU and YOUR LIFESTYLE, CULTURE and/or RELIGION?

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* 10. Are you satisfied with our SKILL, KNOWLEDGE, CONDUCT & the QUALITY of our work?

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* 11. Could we provide A BETTER SERVICE to you?

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* 12. Are you satisfied with the MANAGEMENT AND COST of our support?

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* 13. Overall, are you happy with our support?

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* 14. Do you identify as Aboriginal or Torres Strait Islander?

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* 15. How often do you use the internet to search for health information and advice?

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* 16. If you would like GoCo to see your individual response, please write your name here:

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