WA Country Health Service South West is currently reviewing how it's Community Child Health services have been delivered to Dads in the community and how they have been accessed by Dads.  Our goal is to gather this information from Dads themselves and use this information to change our services to better engage Dads.

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* 1. Where do you currently live? (Please tick)

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* 2. How many children do you have? (Please tick)

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* 3. How old are you? (Please tick)

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* 4. As a Dad have you ever had any experience or contact with community child health services? (Please tick)

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* 5. If yes, how would you rate the service you received? (Please tick)

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* 6. Did the Child Health Nurse include you when providing care for your child? (Please tick)

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* 7. Did our service meet your needs at the time? (Please tick)

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* 8. Have you ever utilised the following services/resources? (Please tick all that apply)

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* 9. If the following services were available, which would you most likely use? (Please tick all that apply)

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* 10. If we were to run a Dads only group please tell us what day and time would be most suitable for you? (Please tick all that apply)

  Morning Afternoon Evening
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

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* 11. Do you have any other suggestions to improve the support provided to you in your important role as a Dad?

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* 12. Your input is greatly valued.  Would you be interested in talking about this further or being a part of planning any changes with us? (Please tick)

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