Client Inclusion Feedback

Client Inclusion Feedback
We welcome all feedback as it helps us to constantly improve our services.

Regardless of the nature of your feedback there will be no negative impact on the services you and your child/dependant receive from PlayAbility. Your feedback will be strictly confidential and you may choose to remain anonymous.

Clients will be supported and encouraged to have an advocate raise feedback on their behalf, if they wish,or accompany/support them to provide feedback during any feedback processes.
Name: (optional)
Date:

Month Day Year
Date
Contact Number: (optional)

Area Code Phone Number
What service is your feedback related to? (please choose all that apply)

Early Intervention Mobile Toy & Parenting Resource Supported Playgroups Indigenous Services
Do you and your family feel respected, safe and included at PlayAbility?

YES NO

Do you and your family feel respected, safe and included at PlayAbility?

	1	2	3	4	5

1 is Not at all, 5 is Absolutley

Do you feel that your service has been free from discrimination?

YES NO

Do you feel that your service has been free from discrimination?

	1	2	3	4	5

1 is Not at all, 5 is Absolutley

Do you feel PlayAbility is respectful of your individual rights?

YES NO

Do you feel PlayAbility is respectful of your individual rights?

	1	2	3	4	5

1 is Not at all, 5 is Absolutley

Do you feel your service from PlayAbility has been fair and equal?

YES NO

Do you feel your service from PlayAbility has been fair and equal?

	1	2	3	4	5

1 is Not at all, 5 is Absolutley

Do you feel like the services and supports that PlayAbility has provided your family were well planned and delivered?

YES NO

Do you feel like the services and supports that PlayAbility has provided your family were well planned and delivered?

	1	2	3	4	5

1 is Not at all, 5 is Absolutley

Do you feel PlayAbility is supporting your family in reaching their goals?

YES NO

Do you feel PlayAbility is supporting your family in reaching their goals?

	1	2	3	4	5

1 is Not at all, 5 is Absolutely

Do you feel PlayAbility staff value your input and opinion?

YES NO

Do you feel PlayAbility staff value your input and opinion?

	1	2	3	4	5

1 is No, 5 is Absolutely

Please leave any other feedback or comments below. Would you like a staff member to contact you about your feedback?
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