Service User Feedback Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please fill out the form to help Support Elite at Home gain feedback on our staff and services. You can fill in this form anonymously if you prefer.

Name

Date

YYYY

Do you know who to call if you have a question or concern about your support?

Yes

Clear selection

How happy are you with the support that you receive from SEAH?

Please use the scale below with 1 being very unhappy and 10 being very happy with the service you receive.

Clear selection

What could we do to improve the support we provide?

Do you feel that we listen to you and support you in the way that you want to be supported?

Please use the scale below with 1 being not listened to and 10 being always listened to.

Clear selection

How could we improve this?

Do you feel that Support Workers understand your situation and the things going on in your life?

Please use the scale below with 1 being not understood and 10 being very understood.

Clear selection

How could we improve this?

Do you feel that Support Workers help you to feel and stay safe?

Please use the scale below with 1 being very unsafe and 10 being very safe

Clear selection

How could we improve this?

Do you feel that the support workers help you to go out and do things that you enjoy?

Please use the scale below with 1 being never and 10 being always

Clear selection

How could we improve this?

Do you feel you are encouraged to make your own decisions?

Please use the scale below with 1 being never and 10 being always

Clear selection

How could we improve this?

Does the support you receive from SEAH make a positive difference to you?

Please use the scale below with 1 being no and 10 being yes

Clear selection

What could we do to improve this?

Do you have any suggestions for how we could do things differently or improve the service we provide?

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report