Gunditjmara Aboriginal Cooperative Ltd
IONMY PUBLICLY AVAILABLE SURVEY
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SURVEY
:
Gunditjmara Feedback Evaluation
PERSON COMPLETING:
(leave blank to submit anonymously)
EMAIL:
Site
Kepler St
Harris St
Banyan St Medical Clinic
Date completed
What program/services did you receive?
We would like to take this opportunity to thank you for accessing our services. We value your input and feedback regarding you and/or your families’ experiences with us. We continue to develop and improve our programs and your feedback is very important to us. Please see our Client Handbook for further information about your Rights and Responsibilities, our privacy requirements and where to go for further information or support. This is a confidential survey and is optional if wish not to participate please advise one of our staff.
Please rate each of the following statements from 1 - 4. 1 - Not Deadly (Completely Disagree), 2 - Somewhat Not Deadly (Somewhat Disagree), 3- Deadly (Somewhat Disagree) and 4 - Too deadly (Strongly Agree).
1. Overall, I am satisfied with my service
4 - Too Deadly (Strongly Agree)
3 - Somewhat Deadly (Somewhat Agree)
2 - Somewhat Not Deadly (Somewhat Disagree)
1 - Not Deadly (Completely Disagree)
2. My service started when I thought it should
4 - Too Deadly (Strongly Agree)
3 - Somewhat Deadly (Somewhat Agree)
2 - Somewhat Not Deadly (Somewhat Disagree)
1 - Not Deadly (Completely Disagree)
3. The staff member attended when they said they would
4 - Too Deadly (Strongly Agree)
3 - Somewhat Deadly (Somewhat Agree)
2 - Somewhat Not Deadly (Somewhat Disagree)
1 - Not Deadly (Completely Disagree)
4. Things got better when working with the staff member
4 - Too Deadly (Strongly Agree)
3 - Somewhat Deadly (Somewhat Agree)
2 - Somewhat Not Deadly (Somewhat Disagree)
1 - Not Deadly (Completely Disagree)
5. I enjoyed working with the staff member
4 - Too Deadly (Strongly Agree)
3 - Somewhat Deadly (Somewhat Agree)
2 - Somewhat Not Deadly (Somewhat Disagree)
1 - Not Deadly (Completely Disagree)
6. The Staff Member asked what was important to me and listened to me
4 - Too Deadly (Strongly Agree)
3 - Somewhat Deadly (Somewhat Agree)
2 - Somewhat Not Deadly (Somewhat Disagree)
1 - Not Deadly (Completely Disagree)
7. I am included in decisions that are made about my service
4 - Too Deadly (Strongly Agree)
3 - Somewhat Deadly (Somewhat Agree)
2 - Somewhat Not Deadly (Somewhat Disagree)
1 - Not Deadly (Completely Disagree)
8. I feel my goals were achieved
4 - Too Deadly (Strongly Agree)
3 - Somewhat Deadly (Somewhat Agree)
2 - Somewhat Not Deadly (Somewhat Disagree)
1 - Not Deadly (Completely Disagree)
9. I am supported and encouraged to participate in my service planning
4 - Too Deadly (Strongly Agree)
3 - Somewhat Deadly (Somewhat Agree)
2 - Somewhat Not Deadly (Somewhat Disagree)
1 - Not Deadly (Completely Disagree)
10. I felt supported to finish up my services with the program
4 - Too Deadly (Strongly Agree)
3 - Somewhat Deadly (Somewhat Agree)
2 - Somewhat Not Deadly (Somewhat Disagree)
1 - Not Deadly (Completely Disagree)
11. Overall, I felt like I was helped, I felt encouraged/motivated on my journey
4 - Too Deadly (Strongly Agree)
3 - Somewhat Deadly (Somewhat Agree)
2 - Somewhat Not Deadly (Somewhat Disagree)
1 - Not Deadly (Completely Disagree)
12. I would recommend Gunditjmara services to others
4 - Too Deadly (Strongly Agree)
3 - Somewhat Deadly (Somewhat Agree)
2 - Somewhat Not Deadly (Somewhat Disagree)
1 - Not Deadly (Completely Disagree)
Please answer these short questions about your experience:
What do you think you like most about the program?
What do you like the least about the program?
Do you feel you were ready to finish services with your program?
Do you have any other comments?
Who helped you complete this?
(Optional) If you would like someone to contact you regarding this feedback, please enter your best contact details
On behalf of the Gunditjmara Aboriginal Cooperative we would like to thank you for your time and input. Please hit the 'Submit' button at the top of this page to complete your survey.
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