Evaluation Form
NO LONGER ON HERE! ASK YOUR GROUP LEADER FOR LINK TO BE SENT FROM THE GMS!

Completing all or part of this evaluation and feedback form is optional however it is a useful tool to consider your current wellbeing.  

Your responses will be anonymously collected by Kintsugi Hope and shared with your group leader. The information you provide  will be used to assist with understanding the impact of the wellbeing groups as well as the overall growth and development of the groups.  Kintsugi Hope may use feedback provided in future marketing and promotional material for the Kintsugi Hope Wellbeing Groups (it will however remain anonymous).  

If you have any additional questions or comments  in relation to this evaluation and feedback form please speak to your Group Leader or email groups@kintsugihope.com.  

Question Title

* 1. Who is your Group Leader? Please write the Full Name

Question Title

* 2. Date of evaluation

Date

Question Title

* 3. Which week are you currently on?

(Choose closest option. All responses are helpful. If you are able to complete an evaluation form at each point it is extremely helpful as your responses may change.)

Question Title

* 4. MENTAL WELLBEING - In the past week

  None of the time Rarely Some of the time Often All of the time
I’ve been dealing with problems well
I’ve been feeling closer to other people

Question Title

* 5. EMOTIONAL WELLBEING - In the past week

  None of the time Rarely  Some of the time Often All of the time
I am happy with who I am
I am in touch with my emotions and able to display them, even the tough emotions

Question Title

* 6. SOCIAL WELLBEING - In the past week

  Strongly Disagree Disagree Agree Strongly Agree
There are people I can depend on to help me if I really need help
I have a close relationship that provides me with a sense of emotional security and wellbeing
There is a trustworthy person I could turn to for advice if I were having problems

Question Title

* 7. OVERALL GROUP FEEDBACK - In the past week

  Strongly disagree Disagree Agree Strongly agree
I have found participating in the Kintsugi Wellbeing Group supportive and helpful
The group is a safe and supportive space
I am learning tools and strategies to help me cope when I’m overwhelmed
The Group Leader is understanding, supportive and communicates well
I would recommend attending a Kintsugi Hope Group

Question Title

* 8. What has been a highlight for you since starting the group?

Question Title

* 9. Has attending the group to date met your expectations?

Question Title

* 10. Please expand on your answer to the above question.

Question Title

* 11. What has been the most difficult thing about being part of the group? 

Question Title

* 12. Have you any other comments you would like to add?

T