Thank you for participating in a Moranbah and District Support Services program.  We are conducting a short survey to find out about your experience and what we might able to do to improve.  We thank you in advance for your assistance.

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* 1. Name: (Optional)

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* 2. Event/Program Attended:

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* 3. Date:

Date / Time

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* 4. How did you feel before attending this event/program?

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* 5. How do you feel now?

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* 6. How would you rate the venue today?

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* 7. How would you rate the event/program today?

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* 8. How would you rate the interaction you had with representative from Moranbah and District Support Services?

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* 9. Would you be likely to refer Moranbah and District Support Services to friends, family or colleagues?

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* 10. Was the information that you received useful?

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* 11. Is there anything information or resources that you would like more information about?

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* 12. Comments:

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* 13. Quotation about your experience:

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