Feedback form

Are you the residential parent or the non-residential parent?

Residential Non-residential

Do you attend for changeovers or supervision?

Changeovers Supervision

How long have you been using the centre?

Less than a year 1-2 years 2-3 years 3-5 years Over 5 years

1. Intake Procedure

	Yes	No
Was it clearly explained to you the type of service that was to be provided?
Did we provide the service that we said we would provide?
Did you receive an explanation of the nature and limits of confidentiality surrounding the service?
Was the fee structure clearly explained to you?
Were you given the opportunity to ask questions or seek further clarification on any issue/s that you did not understand?
Did you feel comfortable during the intake process?

Please add any further comments:

2. Safety & Conflict

	Yes	No
Do you feel that the Centre keeps the two entrances clearly defined?
Do you think your children feel safe and comfortable in the Centre?
As an adult do you feel safe in the Centre environment?
Are you aware of the fire safety evacuation plan located at both entrances to the building?

Have there been any occasions at this Centre when you felt unsafe?

Yes No

If yes, please provide details of the circumstances:

3. Staff

	1. Not at all	2.	3.	4.	5. Always
Do you feel you and your children have been treated with respect and professionalism by the staff?
Do you feel that the staff were sensitive to your individual situation?
You were shown respect for your cultural background and language tradition?
Were the staff able to assist you with any questions you may have had?
Were the staff able to provide appropriate and helpful referrals when necessary?

Please add any further comments:

4. Environment

	1. Poor	2.	3.	4.	5. Excellent
How would you rate the cleanliness of the Centre?
How would you rate the cleanliness of the toys/equipment provided at the Centre?
How would you rate the accessibility of the service?

Do you believe that the fees for the service are reasonable?

Yes No

Do you think the Centre provides enough child friendly, age appropriate toys, equipment and resources?

Yes No

Please add any further comments:

5. Service

	Yes	No
Has using this Service improved the situation that brought you here?
Would you recommend this service to others in similar circumstances?
Based on your experiences using this Centre so far, do you think that you will require the service on a long term basis?
We are currently open 7 days a week from 9:00am – 5:00pm. Do these hours meet your needs?

Please add any further comments:

Are there things that we do well? Please comment:

Are there things we could improve on? Please comment:

Would you like a staff member to contact you to discuss concerns that that you may have?

Yes No

If yes:

Name:

Telephone Number:

Email:

Best contact time: