FEEDBACK FORM

Leave your contact details below to go into a prize draw for a $50 voucher!

Kia ora. Thank you for your confidential feedback - it helps us provide the best possible services. Your feedback will go to the Team Leader.

Question Title

* 1. Which Community Wellbeing service are you providing feedback on?

Kaiapoi Community Support/Foodbank

Family Social Work

Women into Work

New Start

Manu Ka Rere

Transition Kaimahi

Next Steps Facilitator

Restorative Justice

Mana Ake

Aoake Te Ra

Volunteer Driver Scheme

Wellbeing Coordinator

Parent Drop-in

Parenting Groups

WAVES

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* 2. Optional: what is the name of the worker/s?

Question Title

* 3. What do you think the service did well? What has changed?

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* 4. What do you think the service could have done better?

Question Title

* 5. Overall, how satisfied are you with the service/support you (or your family) received?

Very satisfied

Satisfied

Neutral

Not Satisfied

Not satisfied at all

Very satisfied

Satisfied

Neutral

Not Satisfied

Not satisfied at all

Question Title

* 6. What has changed for you (or your family) as a result of the service you received? Please select all that apply.

Improved wellbeing

Increased confidence

Increased awareness of other services

Learned new skills/strategies

Accessed other supports

Improved relationships

Moving towards goals

Another (please specify)

None of the above

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* 7. Thank you for completing this survey. To enter a quarterly prize draw to win a $50 voucher, please write your contact information below.

Name

Phone Number

Question Title

* 8. Can we follow up with you regarding your feedback?

Yes

A big Thank You from the Community Wellbeing team. Kia kaha, kia maia, kia manawanui.
Click here for info on how your privacy is protected.

If you wish to contact the Team Leader directly, email Deirdre Ryan at manager@wellbeingnc.org.nz