Client Satisfaction Survey

By completing this survey you will help us provide better services - Thank you!
- This survey is voluntary but will help us a lot.
- There are no right or wrong answers.
- The quality of the care and support you receive or the way you are treated will not be affected by your answers.

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* 1. CQRH/RHMS Practitioner's name (optional)

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* 2. What is your gender?

Female

Male

Other (please specify)

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* 3. How old are you?

Under 25

25 - 59

60+

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* 4. How many visits/ sessions have you had?

Once only

More than once

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* 5. How long have you been coming to CQRH/RHMS?

A year or less

More than two years

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* 6. Are you or Aboriginal or Torres Strait Islander Descent?

Yes, Aboriginal

Yes, Torres Strait Islander

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* 7. Please rate the following:

	Poor	Fair	Good	Very Good	Excellent	N/A
Making an appointment	Making an appointment Poor	Making an appointment Fair	Making an appointment Good	Making an appointment Very Good	Making an appointment Excellent	Making an appointment N/A
Booking transport (if required)	Booking transport (if required) Poor	Booking transport (if required) Fair	Booking transport (if required) Good	Booking transport (if required) Very Good	Booking transport (if required) Excellent	Booking transport (if required) N/A
Reception (were the staff helpful and respectful?	Reception (were the staff helpful and respectful? Poor	Reception (were the staff helpful and respectful? Fair	Reception (were the staff helpful and respectful? Good	Reception (were the staff helpful and respectful? Very Good	Reception (were the staff helpful and respectful? Excellent	Reception (were the staff helpful and respectful? N/A
Amount of time given for each visit/service/session	Amount of time given for each visit/service/session Poor	Amount of time given for each visit/service/session Fair	Amount of time given for each visit/service/session Good	Amount of time given for each visit/service/session Very Good	Amount of time given for each visit/service/session Excellent	Amount of time given for each visit/service/session N/A
How helpful was your Support Worker/ Practitioner	How helpful was your Support Worker/ Practitioner Poor	How helpful was your Support Worker/ Practitioner Fair	How helpful was your Support Worker/ Practitioner Good	How helpful was your Support Worker/ Practitioner Very Good	How helpful was your Support Worker/ Practitioner Excellent	How helpful was your Support Worker/ Practitioner N/A
How well did CQRH/RHMS staff encourage you to set goals and identify opportunities to meet those goals	How well did CQRH/RHMS staff encourage you to set goals and identify opportunities to meet those goals Poor	How well did CQRH/RHMS staff encourage you to set goals and identify opportunities to meet those goals Fair	How well did CQRH/RHMS staff encourage you to set goals and identify opportunities to meet those goals Good	How well did CQRH/RHMS staff encourage you to set goals and identify opportunities to meet those goals Very Good	How well did CQRH/RHMS staff encourage you to set goals and identify opportunities to meet those goals Excellent	How well did CQRH/RHMS staff encourage you to set goals and identify opportunities to meet those goals N/A
How adequate were the room and facilities provided	How adequate were the room and facilities provided Poor	How adequate were the room and facilities provided Fair	How adequate were the room and facilities provided Good	How adequate were the room and facilities provided Very Good	How adequate were the room and facilities provided Excellent	How adequate were the room and facilities provided N/A

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* 8. Please state your agreement with the following:

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
I was happy with the service I received.	I was happy with the service I received. Strongly Disagree	I was happy with the service I received. Disagree	I was happy with the service I received. Neutral	I was happy with the service I received. Agree	I was happy with the service I received. Strongly Agree
The service was relevant to my needs.	The service was relevant to my needs. Strongly Disagree	The service was relevant to my needs. Disagree	The service was relevant to my needs. Neutral	The service was relevant to my needs. Agree	The service was relevant to my needs. Strongly Agree
I felt my Care/Support Provider listened carefully to me and understood my needs.	I felt my Care/Support Provider listened carefully to me and understood my needs. Strongly Disagree	I felt my Care/Support Provider listened carefully to me and understood my needs. Disagree	I felt my Care/Support Provider listened carefully to me and understood my needs. Neutral	I felt my Care/Support Provider listened carefully to me and understood my needs. Agree	I felt my Care/Support Provider listened carefully to me and understood my needs. Strongly Agree
The quality of the servicies and support provided to my family/friends/carers/advocates by CQRH/RHMS was excellent.	The quality of the servicies and support provided to my family/friends/carers/advocates by CQRH/RHMS was excellent. Strongly Disagree	The quality of the servicies and support provided to my family/friends/carers/advocates by CQRH/RHMS was excellent. Disagree	The quality of the servicies and support provided to my family/friends/carers/advocates by CQRH/RHMS was excellent. Neutral	The quality of the servicies and support provided to my family/friends/carers/advocates by CQRH/RHMS was excellent. Agree	The quality of the servicies and support provided to my family/friends/carers/advocates by CQRH/RHMS was excellent. Strongly Agree
I was involved in the decision making process with the CQRH/RHMS Care/Support Worker.	I was involved in the decision making process with the CQRH/RHMS Care/Support Worker. Strongly Disagree	I was involved in the decision making process with the CQRH/RHMS Care/Support Worker. Disagree	I was involved in the decision making process with the CQRH/RHMS Care/Support Worker. Neutral	I was involved in the decision making process with the CQRH/RHMS Care/Support Worker. Agree	I was involved in the decision making process with the CQRH/RHMS Care/Support Worker. Strongly Agree
I would access CQRH/RHMS services again if I needed help in the future and was eligible to do so.	I would access CQRH/RHMS services again if I needed help in the future and was eligible to do so. Strongly Disagree	I would access CQRH/RHMS services again if I needed help in the future and was eligible to do so. Disagree	I would access CQRH/RHMS services again if I needed help in the future and was eligible to do so. Neutral	I would access CQRH/RHMS services again if I needed help in the future and was eligible to do so. Agree	I would access CQRH/RHMS services again if I needed help in the future and was eligible to do so. Strongly Agree

Client Satisfaction Survey

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* 1. CQRH/RHMS Practitioner's name (optio﻿nal)

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* 2. What is your gender?

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* 3. How old are you?

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* 4. How many visits/ sessions have you had?

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* 5. How long have you been coming to CQRH/RHMS?

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* 6. Are you or Aboriginal or Torres Strait Islander Descent?

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* 7. Please rate the following:

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* 8. Please state your agreement with the following:

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* 9. Any other comments that might help us improve our service?

* 1. CQRH/RHMS Practitioner's name (optional)