Breathing Space

You can also record feedback at www.careopinion.org.uk

Confidential Survey

At Breathing Space we want to know your experience of using our listening service so that we can continue to improve and model Breathing Space to best suit the needs of callers.

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* 1. What age are you?
Breathing Space is available for anyone in Scotland over the age of 16. If you are under 16 years of age, Childline can provide help and advice about a wide range of issues on 0800 1111 or visit www.childline.org.uk

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* 2. Gender:

Female

Male

Prefer not to say

Prefer to self-describe...

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* 3. How did you find out about Breathing Space?

Recommended by GP

Poster/leaflets in GP surgery

Posters/leaflets elsewhere

Recommended by a friend

Recommended by other health professional

Radio advert

Web search

Other (please specify)

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* 4. Have you used Breathing Space before?

Yes

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* 5. What was your main reason for getting in touch?

Anxiety

Low mood

Depression

Stress

Suicidal ideation /self harm

Other (Please state)

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* 6. Any other relevant factors, choose as many as are appropriate to you

Suicidal thoughts/feelings

Relationship issues

Isolation/lonliness

Financial problems

Sexual abuse issues

Domestic violence

Other (please specify)

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* 7. How would you prefer to contact us?

Telephone

Webchat

SMS Text Messaging

Other (Please state)

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* 8. When would you find it most helpful to be able to access our service?

During the Day

Evenings

Weekends

Comment

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* 9. How long did you have to wait to speak to an Advisor?

<5 mins

5-10 mins

10-20 mins

> 20 mins

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* 10. Please rate the quality of the service you experienced?
(Scale: 1= Poor quality to 5=Excellent quality)

	Poor 1	Fair 2	Good 3	Very good 4	Excellent 5	No opinion
I felt listened to	I felt listened to Poor 1	I felt listened to Fair 2	I felt listened to Good 3	I felt listened to Very good 4	I felt listened to Excellent 5	I felt listened to No opinion
The advisor showed empathy	The advisor showed empathy Poor 1	The advisor showed empathy Fair 2	The advisor showed empathy Good 3	The advisor showed empathy Very good 4	The advisor showed empathy Excellent 5	The advisor showed empathy No opinion
I felt understood	I felt understood Poor 1	I felt understood Fair 2	I felt understood Good 3	I felt understood Very good 4	I felt understood Excellent 5	I felt understood No opinion
The advisor helped me to understand how I am feeling	The advisor helped me to understand how I am feeling Poor 1	The advisor helped me to understand how I am feeling Fair 2	The advisor helped me to understand how I am feeling Good 3	The advisor helped me to understand how I am feeling Very good 4	The advisor helped me to understand how I am feeling Excellent 5	The advisor helped me to understand how I am feeling No opinion
My mood has improved	My mood has improved Poor 1	My mood has improved Fair 2	My mood has improved Good 3	My mood has improved Very good 4	My mood has improved Excellent 5	My mood has improved No opinion

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* 11. Overall, how satisfied were you with the service received today?

	Not at all satisfied 1	Slightly satisfied 2	Moderately satisfied 3	Very satisfied 4	Extremely satisfied 5
Quality of service	Quality of service Not at all satisfied 1	Quality of service Slightly satisfied 2	Quality of service Moderately satisfied 3	Quality of service Very satisfied 4	Quality of service Extremely satisfied 5

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* 12. Did you experience any technical issues?
(e.g. volume, clarity, connection)

Yes

If yes, please describe the nature of the problem

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* 1. What age are you? Breathing Space is available for anyone in Scotland over the age of 16. If you are under 16 years of age, Childline can provide help and advice about a wide range of issues on 0800 1111 or visit www.childline.org.uk

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* 2. Gender:

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* 3. How did you find out about Breathing Space?

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* 4. Have you used Breathing Space before?

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* 5. What was your main reason for getting in touch?

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* 6. Any other relevant factors, choose as many as are appropriate to you

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* 7. How would you prefer to contact us?

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* 8. When would you find it most helpful to be able to access our service?

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* 9. How long did you have to wait to speak to an Advisor?

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* 10. Please rate the quality of the service you experienced?(Scale: 1= Poor quality to 5=Excellent quality)

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* 11. Overall, how satisfied were you with the service received today?

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* 12. Did you experience any technical issues?(e.g. volume, clarity, connection)

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* 13. Do you have any suggestions on how we could improve our service to meet your needs?

* 1. What age are you?
Breathing Space is available for anyone in Scotland over the age of 16. If you are under 16 years of age, Childline can provide help and advice about a wide range of issues on 0800 1111 or visit www.childline.org.uk

* 10. Please rate the quality of the service you experienced?
(Scale: 1= Poor quality to 5=Excellent quality)

* 12. Did you experience any technical issues?
(e.g. volume, clarity, connection)

* 13.
Do you have any suggestions on how we could improve our service to meet your needs?