Thank you for agreeing to complete this Carer 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 feel free to contact us.
 
Please note the use of the word "Carer" for the purpose of this survey, includes  family, friends and other people who provide support to people who use our services.

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* 1. What is the name of the worker (staff member) your friend/family member has been seeing?

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* 2. What type of service is being received by your friend/family member?

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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 the Worker (the person providing service) questions?

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* 12. I felt involved in planning the 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 was 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. The rights of my family member/friend were respected

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* 18. The privacy of my family member/friend was respected.

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* 19. The responsibilities of my family member/friend were clearly explained.

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* 20. My role as a Carer was respected

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* 21. I have more confidence supporting the health and wellbeing of my family member/friend.

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* 22. The service 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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