We are looking for feedback from anyone who has used our one-to-one services within the past 6 months. We would be incredibly grateful if you could take some time to fill in this feedback form. Any feedback you may have is invaluable to us as we look to develop our services and support our fundraising efforts by showing the difference our services make. Thank you.
Please indicate which of these one-to-one services you have used within the last 6 months excluding counselling and answer the corresponding questions:
Name of Penny Brohn Doctor seen (if known)
How well did this meet your needs: 1 - not at all, 5 - extremely well
Please give an overall rating for this Doctor: 1 - poor, 5 - excellent
Name of Therapist seen (if known)
Please give an overall rating for this Therapist: 1 - poor, 5 - excellent
Name of Healer seen (if known)
Please give an overall rating for this Healer: 1 - poor, 5 - excellent
5. Music therapy (Guided imagery with music)
How well did this/these session(s) meet your needs: 1 - not at all, 5 - extremely well
Name of Practitioner seen (if known)
Please give an overall rating for this Practitioner: 1 - poor, 5 - excellent
8. Please tell us what difference (if any) using the individual appointments made to you?
Please grade the different parts of our service
Your welcome at the centre: 1 - poor, 5 - excellent
Availability of appointments: 1 - poor, 5 - excellent
Ease of booking appointments: 1 - poor, 5 - excellent
Is there anything that would make the service better for you?
Confidentiality & Data Protection
I agree that my data and information can be held, accessed and processed by Penny Brohn UK for the purposes of evaluation and research. I also agree that my data can be used anonymously in Penny Brohn UK promotional materials. I further understand that all personal data or information I provide to Penny Brohn UK will be kept confidential and that no identifiable personal data will be published, presented or shared with a third party, or made public, without my express consent. I understand that I may withdraw my consent to provide my data at any time without giving a reason. I also understand that my consent is conditional on Penny Brohn UK complying with its duties and obligations under the Data Protection Act (DPA) 1998.*
I agree to the aboveI do not agree to the above
Thank you for your help with this questionnaire. Your feedback is invaluable to us. If you have any questions or would like to know more, please contact firstname.lastname@example.org.