Appointment and Service Feedback Form

Please tell us who you are: *

Client giving feedback / person filling the form out on behalf of the client

Professional giving feedback

Please tell us what appointment you are giving feedback on: *

The assessment appointment

The appointment when equipment was received

The Answers given should reflect those of the client's views of the service they received from Ace Centre.

Please state how much you agree with the following statements.

Scale Guide

Strongly Disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree

The Answers given should reflect those of the client's views of the service they received from Ace Centre.

Please state how much you agree with the following statements.

Scale Guide

Strongly Disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree

Please state how much you agree with the following statements.

Scale Guide

Strongly Disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree

Please state how much you agree with the following statements.

Scale Guide

Strongly Disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree

The information I received was useful *

The location was good for my needs and I could join in *

The type of appointment (online or in-person) was good for my needs and I could join in *

The length of the appointment was good for me *

I feel like I was listened to during the session *

I feel like I had a say in what was decided *

I understand the solutions discussed today *

I understand the plan discussed today *

I know who to go to for help about my communication needs *

I am happy with the recommendations from the session *

The information I received was useful *

The location was good for my needs and I could join in *

The type of appointment (online or in-person) was good for my needs and I could join in *

The length of the appointment was good for me *

My role in supporting the client’s care pathway is clearly defined *

I understand the solutions discussed today *

I understand the plan discussed today *

I have sufficient time to support the next steps *

The location was good for my needs and I could join in *

The type of appointment (online or in-person) was good for my needs and I could join in *

The length of the appointment was good for me *

I understand the plan for using the equipment *

I am happy with the training I received *

I know who to go to for help about my equipment *

I am happy with the service I received from Ace Centre *

The location was good for my needs and I could join in *

The type of appointment (online or in-person) was good for my needs and I could join in *

The length of the appointment was good for me *

I understand the plan for the implementation of equipment *

I am satisfied with the training provided to me *

My role in supporting the client’s care pathway is clearly defined *

I was given guidance in setting targets to support the client in developing their AAC use *

I have sufficient time to support the next steps *

Is there anything else you want to tell us?

How did you join the appointment? *

Face to Face

Remotely (online, voice call, or video call)

How did you join the appointment? *

Face to Face

Remotely (online, voice call, or video call)

Where were you for the appointment? *

Ace Centre premises

At my location (e.g. home, school etc.)

Where were you for the appointment? *

Ace Centre premises

My work location

At client location

How did your SLT/ OT/ Teacher join the appointment? *

Face to Face

Remotely (online, voice call, or video call)

Did not attend

How did the client join the appointment? *

Face to Face

Remotely (online, voice call, or video call)

Did not attend

Where were they for the appointment? *

Ace Centre premises

At their work location

At my location (e.g. home, school etc.)

Did not attend

Where was the client for the appointment? *

Ace Centre premises

At client location

Did not attend

1. Member of Ace Centre staff present * 1. Member of Ace Centre staff present

2. Member of Ace Centre staff present (if more than one) 2. Member of Ace Centre staff present (if more than one)

Your name

Job title *

Client's name

Date of Birth

Post Code

e.g. BD22 4BQ

Appointment and Service Feedback Form

Ace Centre appointment feedback form

Information