Copy of Copy of PALS 2018 Feedback Survey Question Title * 1. Your Name OK Question Title * 2. Are you A Carer Client Family member Guardian OK Question Title * 3. What services do you - or the person you care for receive Individual Support Group Activities Short Term Accommodation (Respite) Shared Supported Accommodation OK Question Title * 4. What town are the services based from Yarrawonga Cobram Numurkah Mooroopna OK Question Title * 5. How would you rate the services PALS provides Very Poor Poor Adequate Good Excellent OK Question Title * 6. What does PALS do well OK Question Title * 7. How can PALS improve OK Question Title * 8. In your view what rights and responsibilities do you view as most important 1 2 3 4 5 6 Right to privacy 1 2 3 4 5 6 Right to choice and control 1 2 3 4 5 6 Freedom from abuse and neglect 1 2 3 4 5 6 PALS being responsive when you want to change things 1 2 3 4 5 6 PALS responding appropriately when things go wrong or you have a complaint 1 2 3 4 5 6 The right to choose your support staff OK Question Title * 9. Are there any rights that you think PALS needs to focus on in the next 12 months and why OK Question Title * 10. Are you satisfied with the services you are receiving Yes No OK Question Title * 11. If you are not satisfied with the services you are receiving - why? OK Question Title * 12. What services would you like to access in the future OK Question Title * 13. How ready do you feel for the NDIS Ready Somewhat Ready Need more help and assistance Not ready at all OK Question Title * 14. What is the best way PALS can assist you to get ready for the NDIS Personal Pre Planning Sessions Community Information Sessions OK Question Title * 15. How would you like your services to change under the NDIS? OK Question Title * 16. How would you rate PALS responsiveness Unresponsive Somewhat responsive Responsive Clear i We adjusted the number you entered based on the slider’s scale. OK Question Title * 17. How would you prefer to receive your information from PALS Email Newsletter Website Social Media OK Question Title * 18. We would love to have a better mailing list for our email - if you consent to receiving information via email please provide your email below. OK Question Title * 19. Would you like us to follow up with you directly on any of the comments provided in this survey? If yes please make sure your name is at the top of the survey. Yes No OK Question Title * 20. Any other comments? OK DONE