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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. For more information on the Feedback and Complaints process, click
here
.
*
1.
Which Community Wellbeing service are you providing feedback on?
(Required.)
Kaiapoi 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
2.
Optional: what is the
name
of the worker/s?
3.
What do you think the service
did well
? What has
changed
for you?
4.
What do you think the service could have
done better
?
*
5.
Overall, how
satisfied
are you with the service/support you (or your family) received?
(Required.)
Very satisfied
Satisfied
Neutral
Not Satisfied
Not satisfied at all
Very satisfied
Satisfied
Neutral
Not Satisfied
Not satisfied at all
*
6.
What has
changed
for you (or your family) as a result of the service you received? Please select all that apply.
(Required.)
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
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
8.
Can we follow up with you regarding your feedback?
Yes
No
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
