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Consumer Feedback Form
Full Name
*
Q1. Are you a consumer or a consumer's representative?
I am a consumer of home services
I am a carer or representative answering on behalf of a consumer of home services
If you are a consumer's representative, please answer these questions on behalf of the consumer
Q2. Do staff treat you with respect?
Always
Most of the time
Some of the time
Never
Q3. Are Support staff competent in services required?
Always
Most of the time
Some of the time
Never
Q4. Do staff follow up when you raise things with them?
Always
Most of the time
Some of the time
Never
Q5. Are the staff regularly on time?
Always
Most of the time
Some of the time
Never
Q6. Do you participate in making decisions about what services are provided?
Always
Most of the time
Some of the time
Never
Q7. Do you get the services you need?
Always
Most of the time
Some of the time
Never
Q8. How often are services updated?
Always
Most of the time
Some of the time
Never
Q9. Do the services help you to live life the best you can?
Always
Most of the time
Some of the time
Never
Q10. Is the information that you are given about services easy to understand?
Always
Most of the time
Some of the time
Never
Q11. Are you happy with the Rubies Community care?
Always
Most of the time
Some of the time
Never
Q12. What is the best thing about Rubies Community Care's service?
Q13. How could Rubies Community Care be improved?
Q14. Do you speak a language other than English at home?
*
No
Prefer not to say
Yes
If yes, what language?
*
Q15. Any additional comments?
Submit
Name
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