Thank you for agreeing to complete the Client Satisfaction Survey. We value your opinion about your experience with us. The feedback you provide will be kept confidential and will help us to improve our services. If you need assistance in completing this survey please don't hesitate to contact us.

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* 1. What is the name of the worker (staff member) you have been seeing?

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* 2. What type of service are you receiving?

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* 4. Please enter today's date

Date / Time

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* 5. What is your post code?

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* 6. What is your Gender?

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* 7. Approximately how many times have you been seen ?

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* 8. Are you of Aboriginal or Torres Strait Islander heritage?

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* 9. Do you identify as having a Culturally and Linguistically Diverse (CaLD) background i.e. either you or at least one of your parents were born in a country where English is not the traditional language?

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* 10. Is English your first language?

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* 11. I felt comfortable asking my Worker (the person providing service) questions?

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* 12. I felt involved in planning my care.

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* 13. I would recommend this service to my family and friends

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* 14. I was satisfied with the service that I received.

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* 15. The location was convenient to me

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* 16. The waiting time to receive the service was reasonable

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* 17. My rights were respected

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* 18. My privacy was respected.

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* 19. My responsibilities were clearly explained.

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* 20. After receiving care from this service I have more confidence managing my health and well being.

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* 21. With my consent, my carer/family/nominated support person was involved in my care.

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* 22. The service I received was culturally appropriate.

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* 23. Optional, What else would you like us to know about your satisfaction with this service?  Please feel free to provide suggestions as to how we can improve our service

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