Exit Vocational Rehabilitation Service - Stay At Work Client Satisfaction Survey Question Title * 1. Demographics (as registered with ACC) Male Female Prefer not to say Another gender Question Title * 2. What is your age? 17 or younger 18-20 21-29 30-39 40-49 50-59 60 or older Question Title * 3. What is your ethnic background? NZ European/Pakeha NZ Maori Chinese Cook Island Maori European Fijian Indian Niuean Samoan South East Asian Tokelauan Tongan Other Asian Other Pacific Other Ethnic Group I'd prefer not to say Question Title * 4. Which region do you live in? Northland Auckland Waikato Bay of Plenty Gisborne Hawkes Bay Wellington and Kapiti Wairarapa Manawatu Taranaki Nelson/Marlborough Canterbury Otago Central Otago Southland West Coast Question Title * 5. How satisfied were you in your level of involvement in the development of your plan? Very satisfied Satisfied Neither satisfied nor dissatisfied Dissatisfied Very dissatisfied Question Title * 6. Overall, how well do you think we coordinated with your GP, employer, other treatment providers and rehabilitation specialists? Very well Well Neutral Not well Not at all well Question Title * 7. Did you have any cultural needs that you needed taken into consideration? Yes No Question Title * 8. If you answered Yes to the above, how well do you feel we considered your cultural needs? Very well Well Neutral Not well Not at all well Question Title * 9. Overall, how satisfied are you with the services that you received from us? Very satisfied Satisfied Neither satisfied or dissatisfied Dissatisfied Very dissatisfied Question Title * 10. How easy were your programme plans and reports to understand? Very easy Easy Neutral Difficult Very difficult Question Title * 11. How much did the service to you help in achieving a good outcome? Greatly Partly Neutral Not really Not at all Question Title * 12. Was a Telehealth* appointment included as part of your service? (*video assessment in place of a face-to-face appointment) Yes No Question Title * 13. If yes, how effective did you find your Telehealth appointment(s)? 0 10 Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 14. Please provide any feedback relating to your Telehealth experience so we can make improvements and ensure optimal service is being delivered. Question Title * 15. How likely is it that you would recommend our service to a friend or colleague? Not at all likely Extremely likely 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Question Title * 16. Please provide any general comments you may wish to make, regarding the rehabilitation or services received. Question Title * 17. If you would like to be contacted please leave your name and contact details below. Done