To complete while client is undergoing program

Njernda Aboriginal Corporation is committed to providing high quality care and services and meeting your needs. We value your feedback so that we can ensure we are meeting your individual needs and are providing you with all the information you need. Please let us know what we do well and where we can improve our services.

Question Title

* 1. Do you wish to remain anonymous?

Question Title

* 2. If NO to Q1 please provide the information requested below?

Question Title

* 3. Are you providing feedback on another persons behalf?

Question Title

* 4. If YES please provide details.

Question Title

* 5. Are you the legal representative? ( Parent, Carer or Guardian of the person you are acting on behalf of in Q4)

Question Title

* 6. Does the person of Q4 know you are providing feedback on their behalf?

Question Title

* 7. Are we able to speak with the person who received the service?

Question Title

* 8. Please provide details of the service that this feedback concerns. You can check more than one box.

Question Title

* 9. Were you happy with the amount of information we gave you to understand your rights and responsibilities?

Question Title

* 10. Do you need additional support to exercise your rights and responsibilities? You can check more than one.

Question Title

* 11. Have you been given enough information about the service / program you are undertaking?

Question Title

* 12. Have you been supported to identify your strengths weakness and goals with the aim of building on these?

Question Title

* 13. Have you been offered information or support to engage and participate with the community?

Question Title

* 14. Do you feel you are adequately engaged in your service delivery?

Question Title

* 15. Is your assessment and service delivery taking into account your age, ability, gender, identity, culture, religion or spirituality?

Question Title

* 16. Were you offered a copy of your care plan?

Question Title

* 17. For Parents, Carers or Guardians do you require more information to assist the development of your child?

Question Title

* 18. Is there any way we can improve our service?

Question Title

* 19. If YES, have you discussed these with your worker?

Question Title

* 20. What would you like to happen as a result of providing this feedback?

Njernda Aboriginal corporation is committed to protecting your privacy. We collect and handle personal information that you provide on this feedback form for the purpose of investing and responding.
Njernda will only use your information in accordance with relevant privacy and other laws. in order for us to provide services to you, affectively and efficiently we may need to she your information with other staff members who deal with the matters identified in your feed back. if you choose to remain anonymous Njernda may be unable yo deliver the full rang if services you require. If you wish to contact the manger who is responsible for managing the personal information you provide on this form, please call 03 5480 6252 and ask for the manager of the department your services are delivered from.
Your also have the right to access your information and seek its correction under the Freedom of Information act 1982. For information about making a Freedom of Information application contact your manger or case worker on 03 5480 6252.

Question Title

* 21. I declare that this information is true and correct.

Question Title

* 22. Please Date

Date
Thank you for taking the time to provide feedback about our service.

T