Client Feedback Form - Complaint or Concern

Thank you for using POhWER. We are sorry to hear that you are unhappy with the service we offered you. We would like to know what went wrong. Your feedback will help us to find out what went wrong so we can look at making sure this does not happen again and make sure we are supporting people in the right way.

We would really appreciate it if you could take a few minutes to answer these questions, if you need a paper copy of this form sending to you please call our information support centre on 0300 456 2370, or you can ask them to help you and complete this form with you over the telephone.

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* 1. Your name

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* 2. Your contact details

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* 3. Name of the person/service you want to tell us about

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* 4. Which area of the country do you live in?

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* 5. Which of our services did you use?

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* 6. Is this a complaint or concern?

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* 7. What went wrong with the service we were offering to you? (please select those that apply)

Staff working practice

Staff attitude

Outcome of the service

Communication

Other

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* 8. Please tell us in more detail about the concern or complaint you want to tell us about.

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* 9. If you were unsatisfied with our support and the service we provided please tell us why (Please tick all that apply, you can choose more than one option)

My advocate made it difficult for me to tell them what had gone wrong or what I was worried about

My advocate did not work on my case in a timely way

My advocate did not answer my questions or explain things to me in a way I could understand my options and choices

My advocate did not give me the information, support and help I needed to help me with my problem

Other

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* 10. Would you like to share your experience of working with POhWER with one of our managers?

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* 11. Would you like any information about any of our other services?

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* 12. Do you have any suggestions how we can improve our services and work better with people in a similar situation to you?

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* 13. Please use this box to let us know anything else about the services you received from POhWER.

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* 14. Are you completing this form on behalf of someone else?

If yes, please enter your name and position

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* 15. Enter the Contract Code if known

If you would like any information about any of our other services, please call 0300 456 2370 or visit our website, www.pohwer.net