Grenfell Health and Wellbeing Service Feedback Form (Children)

We would like to invite you to share your experience of the Grenfell Health & Wellbeing Service (GHWS) with us. We want to know what you think about our service. Please complete the questions below to let us know how we are doing and if we can do anything better.

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* Where did you meet your therapist? (Tick all that apply)

St Charles Centre for Health and Wellbeing

Telephone

At Home (In person)

Video (Online)

Other

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* Do you like where you met your therapist? (Please tick)

0 = Not at all

5 = I really liked it

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* Could you tell us more about this?

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* What support are you receiving at the GHWS? (tick all that apply)

Therapy on my own

Therapy with my family

Therapy with other children

Therapy with my parent

Unsure

Other

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* Do you find talking to your therapist helpful? (Please tick)

0 = Not helpful at all

5 = Very helpful

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* Could you tell us more about this?

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* Do you feel like your therapist is listening to you? (Please tick)

0 = They do not listen to me

5 = They really listen to me

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* Could you tell us more about this?

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* Do you find the service welcoming? (Please tick)

0 = Not welcoming at all

5 = Very welcoming

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* Could you tell us more about this?

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* Any other comments/suggestions for GHWS?

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* About You: (Optional)

Name (if you want to be contacted about your feedback)

Ethnicity

Age

Gender

Postcode

Preferred Language

Please provide contact details if you wish to be contacted to discuss your feedback

Your details will be treated in accordance with the Data Protection Act 1998 and will not be shared with any third parties. If you would prefer not to be contacted your anonymous feedback is still extremely valuable to us.

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* Thank you for taking the time to complete this feedback form.

Tick to consent to the use of anonymised quotes from your feedback to promote the service.

Tick if you are interested in receiving further information about service user involvement.