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GoCo Feedback Form
1.
I am a:
Client
Volunteer
Carer/Family
Supplier/Partner
Staff
Other (please specify)
2.
This feedback is in relation to:
Home Care Package
Meals on Wheels
Social Support
Care & Housing
Home & Garden Maintenance
Assistive Equipment
Groups
Transport
Respite
Other (please specify)
3.
Please describe your compliment, complaint or idea using as much detail as possible. We take all comments very seriously.
4.
On a scale of 0 to 10,
How likely is it that you would recommend this service to a friend or colleague?
0 for Not at all likely, 10 for Extremely likely
Not at all likely
Extremely likely
0
1
2
3
4
5
6
7
8
9
10
5.
Contact details:
Name
City/Town
Email Address
Phone Number
