Carers WA Social and Peer Support Program - Linking Together Feedback Form Survey

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* 1. How did you originally find out about the Social Support Program?

Carers WA Newsletter

Carers WA E-mail

Carers WA Event

Service Provider

Newspaper Ad

Word of Mouth

Website

Other (please specify)

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* 2. How long have you been attending?

Less then one year

One plus year

Two plus years

Three plus years

Four plus years

Other (please specify)

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* 3. In regards to services received for yourself, or the person you care for:

	Yes	No	Unsure
Do you receive any services in or out of the home?	Do you receive any services in or out of the home? Yes	Do you receive any services in or out of the home? No	Do you receive any services in or out of the home? Unsure
Do you receive any HACC services?	Do you receive any HACC services? Yes	Do you receive any HACC services? No	Do you receive any HACC services? Unsure
Do you receive any Disability services?	Do you receive any Disability services? Yes	Do you receive any Disability services? No	Do you receive any Disability services? Unsure
Do you receive any other services in or out of the home?	Do you receive any other services in or out of the home? Yes	Do you receive any other services in or out of the home? No	Do you receive any other services in or out of the home? Unsure

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* 4. What was the most valuable aspect of the Social Support program for you?

	Yes	No	Unsure
Making new friends who understand caring roles	Making new friends who understand caring roles Yes	Making new friends who understand caring roles No	Making new friends who understand caring roles Unsure
Information and referrals to other services	Information and referrals to other services Yes	Information and referrals to other services No	Information and referrals to other services Unsure
Reduces isolation and links with wider community	Reduces isolation and links with wider community Yes	Reduces isolation and links with wider community No	Reduces isolation and links with wider community Unsure
Emotional, physical and mental support for wellness	Emotional, physical and mental support for wellness Yes	Emotional, physical and mental support for wellness No	Emotional, physical and mental support for wellness Unsure

The following questions are in relation to Linking Together Carer groups:

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* 5. Are there things you will change at home or in your caring role after attending the support group?

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* 6. It is important to have a break and look after your own mental and physical wellbeing, what types of activities or services could you help with this?

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* 7. How do you feel about the staff/volunteers facilitating the support group?

	Strongly agree	Agree	Disagree
Was knowledgeable	Was knowledgeable Strongly agree	Was knowledgeable Agree	Was knowledgeable Disagree
Was well prepared and had lots of information	Was well prepared and had lots of information Strongly agree	Was well prepared and had lots of information Agree	Was well prepared and had lots of information Disagree
Was engaging and interesting	Was engaging and interesting Strongly agree	Was engaging and interesting Agree	Was engaging and interesting Disagree
Encouraged participation and discussion	Encouraged participation and discussion Strongly agree	Encouraged participation and discussion Agree	Encouraged participation and discussion Disagree

Comments

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* 8. How do you feel about the venue/s?

	Excellent	Good	Poor
The venue	The venue Excellent	The venue Good	The venue Poor
The catering	The catering Excellent	The catering Good	The catering Poor
The location/ travel/ parking	The location/ travel/ parking Excellent	The location/ travel/ parking Good	The location/ travel/ parking Poor

Comments

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* 9. Please provide suggestions for improving future services:

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* 10. Would you be interested in learning more about Carers WA?

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* 11. Please provide your name and contact details if you would like to disclose

Thank you for participating today and completing the evaluation questions for us. Your responses will be collated and used to improve the events for other carers.