KMCSS Whanau Feedback Form

Name*

First Last Suffix

Entering your name is optional totally optional however please understand that if there are any concerns, we would like to discuss these further with you. Information collected in this survey is for the sole purpose outlined above.

Contact Phone Number

In case we need to contact you to discuss anything further.

Today's Date*

Did you feel services offered by Te Tomika Trust have helped the overall health and well-being of your whanau member?*

Yes
Maybe
No

Were meetings/visits held at a convenient time for you?*

Yes
No

Did you feel listened to by our staff/kaimahi?*

Yes
No

Do you feel that, what was important to you, was understood by our kaimahi/staff?*

Yes
No
Not sure

What did you find helpful or positive during the support process?*

Was there anything you didn't find helpful during the support process?

On a scale of 1 to 5, how would you rate the overall support you received from the Community Support Service of Te Tomika Trust?*

Select All
1 - Very Good
2 - Good
3 - Ok
4 - Poor
5 - Very Poor

Please use this box to add any further comments.*

Community Support Services - Whanau Feedback Form

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