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Ice-Breaker Form Survey

1.How easy or difficult was it to access, download and print the Ice-Breaker Form?
2.How easy or difficult was it to answer the questions in the Ice-Breaker Form?
3.What could have been done to improve your experience of downloading, printing and completing the Ice-Breaker Form?
4.Who did you discuss the details you'd written on the Ice-Breaker form with?(Required.)
5.Before you discussed the Ice-Breaker with the person, how much did you trust them you to make decisions that are in your best interests?
6.How well did the person actively listen to your needs?
7.How well did the person answer your questions?
8.What treatment options did the person suggest?(Required.)
9.How well did the person explain your treatment options?
10.How well did the person explain your follow-up care?
11.How satisfied or dissatisfied were you with the amount of time the person spent with you addressing your needs?
12.Overall, how satisfied or dissatisfied were you with the conversation you had with the person about what you'd written on the Ice-Breaker Form?
13.Overall, how would you rate the care you received from the person you spoke with about the Ice-Breaker Form?
14.AFTER you discussed the Ice-Breaker with the person, how much did you trust them you to make decisions that are in your best interests?
15.What could have been done to improve your experience of discussing what you'd written on the Ice-Breaker Form with the person you spoke with?
16.Overall, how would you rate the usefulness of the Ice-Breaker Form to start a conversation about the issues you wrote on the form?
17.How satisfied or dissatisfied were you with the treatment options you tried?
Very satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Very dissatisfied
N/A
Cognitive Behavioural Therapy (CBT)?
Other therapy?
Support from social care (Social Services)?
Practical support from a Professional Hoarding Practitioner or Professional Organiser?
Safe and Well (Home Fire Safety) visit from the Fire & Rescue Service
Attend a Hoarding Support Group?
Attend another Support Group?
Phone a Helpline?
Emotional Freedom Technique (EFT)?
18.How long did you persevere with the treatment options?
1 session
2-5 sessions
6-10 sessions
11-20 sessions
More than 20 sessions
Still ongoing 
N/A
Cognitive Behavioural Therapy (CBT)?
Other therapy?
Support from social care (Social Services)?
Practical support from a Professional Hoarding Practitioner or Professional Organiser?
Safe and Well (Home Fire Safety) visit from the Fire & Rescue Service
Attend a Hoarding Support Group?
Attend another Support Group?
Phone a Helpline?
Emotional Freedom Technique (EFT)?
19.How much has the therapy helped you overcome the difficulties you were experiencing that were affecting your health?
20.How much has your health improved as a result of the therapy you chose?
21.How much would you rate the Ice-Breaker form and recommend other people to use it to get help and support?
Poor
Fair
Good
Very good
Excellent