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* 1. Your age:

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* 2. Is English your first language?

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* 3. Do you identify as an ABORIGINAL &/OR TORRES STRAIT ISLANDER?

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* 4. In which LOCAL GOVERNMENT AREA do you live?

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* 5. Please tick how you rank our support:

  Strongly agree Agree Unsure or neutral Disagree Strongly disagree
I am given the care and services that I need. (18)
I understand my support choices, service agreement, support plan and the fees I have to pay.
I understand other information GoCo has provided (eg about how to complain and what my rights are).
I believe I am given choice in care and service provision. (22)
The services provided to me are planned and reliable (eg assistance is provided on the days/times agreed). (19)
I feel confident with the way the staff provide care and services to me. (17)
Staff/volunteers support me to be independent and able to participate in my local community. (27)
The staff know what is important to me and respect my needs and preferences (lifestyle, customs, culture, language and my religious and spiritual preferences). (24)
Staff listen to me and respond quickly and sensitively to my needs. (25)
I feel comfortable about making a complaint if I need to. (30)
I am generally happy with the care and services I receive. (8)
My quality of life has improved since the service started. (34)

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* 6. Could we provide A BETTER SERVICE to you?

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* 7. If you would like GoCo to see your individual response please write your name here:

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