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Your feedback
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Thank you for choosing to leave feedback about the service you have received from ASNEW
The information you provide us is for: monitoring performance, developing services and to make the service accountable in order to show effectiveness. No personal information is retained from this form* and all statistical evidence produced is in complete anonymity.
*unless requested below for the purposes of discussing the service you have received from ASNEW.
Who was your allocated Advocate?
*
Please choose
Abigail
Bethan
Chris
Daniel
David
Gaynor
Helen
Jennifer
John
Nicola
Richard
Rowan
Suzanne
Not Sure
Which service did you use?
Please choose
Community / General Advocacy
Carers Advocacy
IMHA
IMCA
RPR
IPA
Not Sure
Your Experience
Rate 1 out of 5
Rate 2 out of 5
Rate 3 out of 5
Rate 4 out of 5
Rate 5 out of 5
Overall, how would you rate your experience with us?
How can we improve?
At ASNEW we strive to provide the best service possible, Please let us know how you feel we can do better.
How did you find out about ASNEW's services?
Please choose
Leaflet
Poster
Friend/Family
I am a previous client
Hospital staff
Advocacy staff
Social Services
ASNEW.org.uk
Search engine e.g. Google, Bing
Other
Please state
How easy was it for you to access ASNEW?
Very Difficult
Difficult
Neither Difficult nor Easy
Easy
Very Easy
Very Difficult
Item #1 Very Difficult
Difficult
Item #1 Difficult
Neither Difficult nor Easy
Item #1 Neither Difficult nor Easy
Easy
Item #1 Easy
Very Easy
Item #1 Very Easy
To what extent do you agree or disagree with the following statements?
Please select one answer per row
My advocate
Strongly Disagree
Disagree
Neither Agree nor Disagree
Agree
Strongly Agree
was clear about their role
Strongly Disagree
was clear about their role Strongly Disagree
Disagree
was clear about their role Disagree
Neither Agree nor Disagree
was clear about their role Neither Agree nor Disagree
Agree
was clear about their role Agree
Strongly Agree
was clear about their role Strongly Agree
kept their appointments
Strongly Disagree
kept their appointments Strongly Disagree
Disagree
kept their appointments Disagree
Neither Agree nor Disagree
kept their appointments Neither Agree nor Disagree
Agree
kept their appointments Agree
Strongly Agree
kept their appointments Strongly Agree
did what they said they would
Strongly Disagree
did what they said they would Strongly Disagree
Disagree
did what they said they would Disagree
Neither Agree nor Disagree
did what they said they would Neither Agree nor Disagree
Agree
did what they said they would Agree
Strongly Agree
did what they said they would Strongly Agree
expressed my views clearly
Strongly Disagree
expressed my views clearly Strongly Disagree
Disagree
expressed my views clearly Disagree
Neither Agree nor Disagree
expressed my views clearly Neither Agree nor Disagree
Agree
expressed my views clearly Agree
Strongly Agree
expressed my views clearly Strongly Agree
I feel
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
respected
Strongly Disagree
respected Strongly Disagree
Disagree
respected Disagree
Neutral
respected Neutral
Agree
respected Agree
Strongly Agree
respected Strongly Agree
supported
Strongly Disagree
supported Strongly Disagree
Disagree
supported Disagree
Neutral
supported Neutral
Agree
supported Agree
Strongly Agree
supported Strongly Agree
listened to
Strongly Disagree
listened to Strongly Disagree
Disagree
listened to Disagree
Neutral
listened to Neutral
Agree
listened to Agree
Strongly Agree
listened to Strongly Agree
I would
Very Unlikely
Unlikely
Neutral
Likely
Very Likely
use ASNEW again
Very Unlikely
use ASNEW again Very Unlikely
Unlikely
use ASNEW again Unlikely
Neutral
use ASNEW again Neutral
Likely
use ASNEW again Likely
Very Likely
use ASNEW again Very Likely
recommend ASNEW to others
Very Unlikely
recommend ASNEW to others Very Unlikely
Unlikely
recommend ASNEW to others Unlikely
Neutral
recommend ASNEW to others Neutral
Likely
recommend ASNEW to others Likely
Very Likely
recommend ASNEW to others Very Likely
Do you have any additional comments or suggestions?
I would
*
like to remain anonymous
like to leave my contact details so that I can be contacted about my feedback
Please be assured that any concerns raised will NOT affect the service you receive from ASNEW either now or in the future.
Name
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Last
Phone
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Equal Opportunities - Equality and Diversity
Advocacy Services North East Wales believe in equal opportunities for everyone. Although this section is voluntary, we ask you to please help us to monitor our service procedures by completing the following questions.
I identify my gender as...
Please select
Female
Male
Transgender
Genderqueer
Agender
Genderless
Non-binary
Cis Man
Cis Woman
Third Gender
Two-Spirit
Bigender
Genderfluid
Other (please state)
Other gender:
My sexual orientation is...
Please select
Straight/Heterosexual
Gay or Lesbian/Homosexual
Bisexual
Other sexual orientation (please state)
Other sexual orientation:
Do you consider yourself to have a disabilty?
Please select
Yes
No
How would you describe your disability?
What is your ethnic background?
Please select
Asian or Asian British
Black or Black British
Mixed
White
Other
Asian or Asian British -
Bangladeshi
Chinese
Indian
Pakastani
Other
Black or Black British
African
Caribbean
Other
Mixed -
Asian and White
Black African and White
Black Caribbean and White
Other
White -
Welsh
English
Scottish
Northern Irish
British
Gypsy or Irish Traveller
Irish
Other
Other -
Arab
Any other
Any other:
Your age range
Please select
Under 18
18-24
25-34
35-49
50-64
65-74
75-84
85-94
95+
Do you live in a rural area?
Yes
No
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