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Feedback Form
We would like you to think about your most recent experience with the Muscular Dystrophy Association
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1.
What part of our service did you interact with? Please click on the arrow and select the best option from the list.
(Required.)
Information Service
Fieldworker Service
Accounts & Fundraising
Branch Office Manager
Branch - Other
National Office - Other
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2.
How did you feel following your experience with the MDA? (Select as many options as you like)
(Required.)
Positive
Valued
Responded to
Connected
Supported
Informed
None of the above (please specify)
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3.
How likely are you to recommend our service to Friends, Whānau, Colleagues or Patients if they needed similar support or information?
(Required.)
Extremely unlikely
Unlikely
Neither likely or unlikely
Likely
Extremely likely
Extremely unlikely
Unlikely
Neither likely or unlikely
Likely
Extremely likely
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4.
Please can you tell us the main reason for the score you have given?
(Required.)
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5.
I am a...
(Required.)
MDA Member
Health Professional
Whānau Supporter
Donor
Community Member
Other (please specify)
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6.
Please select from the list below to show the region you are based in (or the nearest one)
(Required.)
Northland
Auckland
Waikato
South Waikato, Bay of Plenty
Rotorua, Taupo
Gisborne, Napier
Taranaki, Whanganui
Mid Central
Wellington
Nelson, Blenheim
West Coast
Kaikoura, North Canterbury
Christchurch, South Canterbury
Otago
Southland
7.
Is there anything else you would like to tell us?
