Client Feedback Form
We are very keen to improve the service we provide to individuals wanting to stop smoking. Your views about this are very important to us and will be treated in the strictest confidence. Please answer the following questions as honestly as you can. The results of this survey will be used for evaluation and to improve services for the future.
Overall, how satisfied are you with the service you received? *
Very Unsatisfied
Very Satisfied
Would you recommend our service to your family/friends? *
If you started smoking again would you return to the service for help to stop? *
Was it easy to contact the stop smoking service? *
Were you offered a range of times and venues to attend? *
How would you rate the support you received from your advisor? *
Very Unhelpful
Very Helpful
How long did you have to wait for your first appointment? *
Was it helpful having your carbon monoxide (CO) reading done (blowing into portable machine)? *
Were you offered a choice of medication? (Champix, E-cigs, patches, gum, mouth spray, inhaler, strips, lozenges, etc.) *
Was it easy to obtain your medication? *
How did you hear about the Stop Smoking Service? *
Do you have any further comments you would like to add?
Please complete the contact details section below if you would like to be contacted by a member of the Smokefree Hampshire team.
Please use the space below to write an optional quote about your experience of stopping smoking and the Smokefree Hampshire service.
Please note by submitting this information you give consent for Smokefree Hampshire and Solutions 4 Health to use your quote on social media, on their website and on other promotional materials
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