POSITIVE VIBES HEALTHY LIVES
This short survey should only take 5-10 minutes of your time to complete. For more info please visit https://whitestonesurgery.org/positivevibeshealthylives
1. Which of the following activities would you enjoy taking part in if they were available at Whitestone Surgery for young people? (Please tick all that apply) *
Required
If you answered 'none of the above' please state why:
Your answer
2. If Whitestone Surgery offered support groups and activities for young people, would you use them? *
Please explain:
Your answer
3. Do you have any ideas for activities or support groups that Whitestone Surgery could offer for young people? *
Please explain:
Your answer
4. How would you describe the support for young people at Whitestone surgery? *
5. How often do you socialise? *
6. If you wanted to socialise more often, what would encourage you to do this? *
Required
Other (please specify):
Your answer
7. How often do you feel you are able to communicate with people around you about your worries and stressors? (This may include school/college stress, friendships/family problems etc). *
8. Are you Male/Female? *
9. How old are you? *
Your answer
Thank you for your time. Your voice matters to us and we would like your input to help us develop activities for young people. This short survey is anonymous and the information that you have provided will be used solely for this purpose. If you wish to fill in contact details, please indicate you have the permission from your parent/guardian. You can withdraw your data at any time. For any further information or questions, please contact Keeley at Whitestone Surgery on 024 7664 1911.
Would you be interested in getting involved? *
If you would like to be contacted for any further information please enter your details below. If you wish for your response to remain anonymous please leave this section blank.
Name:
Your answer
Parent/Guardian name and contact details (e-mail or phone number):
Your answer
Parent/Guardian permission to be contacted:
To view our privacy policy please click here: https://whitestonesurgery.org/privacypolicy
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service