Participant Survey
1.
Person providing feedback:
☐ Participant
☐ Family member
☐ Representative
☐ Plan Manager
☐ Support Coordinator
Other (please specify)
2.
Name (optional):
3.
When thinking about your first experience of contacting and meeting Kern staff, please consider the extent to which you agree or disagree with the following statements:
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
My experience was positive
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
The staff were knowledgeable and helpful
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
I felt confident that the services received would meet my expectations
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
I felt heard and understood
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
All my/my family member’s questions were answered
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
4.
When thinking about your current Kern service, please consider the extent to which you agree or disagree with the following statements:
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
My Key Worker is knowledgeable and helpful
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
My therapy team is knowledgeable and helpful
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
I feel confident in my therapy team’s ability to help reach my goals and achieve positive outcomes
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
I have choices about how and when therapy is delivered
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
My/ my family member’s privacy and confidentiality is always respected
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Kern staff have provided me with relevant documentation to support me during my NDIS plan review process
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
5.
I have received a copy of Kern’s Easy Read Feedback and Complaints Brochure:
Yes
No
Unsure
6.
I have received a copy of Kern’s Easy Read Guide to the Service Agreement
Yes
No
Unsure
7.
When thinking about your Kern service experience overall, please consider the extent to which you agree or disagree with the following statements:
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
I feel comfortable providing feedback about Kern or making a complaint
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
I know how to provide feedback about Kern or make a complaint
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Overall, I am happy with the service Kern provides
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
The service I have received from Kern so far has met my expectations
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
I would recommend Kern therapy supports to others
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
8.
If you disagreed or strongly disagreed with any of the above questions, what suggestions do you have for Kern to improve the quality of service delivery or our policies and procedures?
9.
Is there anything that Kern does particularly well that we should keep doing?
10.
If you self manage your funding, or have a Plan Manager, do you have any feedback on Kern’s system of invoicing? (Leave blank if not applicable)
11.
Are there any other therapy related services and supports you would like Kern to offer?
12.
Are there any policies and/or procedures you would like a copy of, or would like to provide feedback on?
Thank you for taking the time to complete this form.
Your honest feedback is highly valued and will enable us to continually improve Kern Allied Health services.
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