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Whānau Evaluation Form
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Hauora Feedback Form
Whānau Evaluation Form
DATE
*
Date Format: DD slash MM slash YYYY
NAME
Your name
Email
*
Services(s) Currently Provided To You
*
Whānau Ora
Early Intervention Service
Rongoā Māori
Disability Information & Advocacy Service
Taurite Tū
1-Very Well
2-Above Average
3-Average
4-Below-Average
5-Poor
1. Huria Trust Hauora Service(s)
Please Tick
1.1 Did the service(s) meet your needs
*
1. Very Well – 5. Poor
1
2
3
4
5
1.2 Did the service(s) assist in improving your health and wellbeing?
*
1. Very Well – 5. Poor
1
2
3
4
5
1.3 Did we assist you in a friendly, courteous and timely manner when you accessed the service(s)?
*
1. Very Well – 5. Poor
1
2
3
4
5
What did you like about the service(s)
Please comment
Where can we improve?
Recommendations
2. Huria Trust Kaiāwhina
Please tick
2.1 Did the Kaiāwhina engage with you in a timely manner?
*
1. Very Well – 5. Poor
1
2
3
4
5
2.2 Did the Kaiāwhina regularly inform or update you throughout the services(s) provided to you?
*
1. Very Well – 5. Poor
1
2
3
4
5
2.3 Did the Kaiāwhina provide you with enough information to make informed decisions about your health & wellbeing?
*
1. Very Well – 5. Poor
1
2
3
4
5
Comments
3. Overall
3.1 Did we provide a quality service to you and/or your whānau?
*
1. Very Well – 5. Poor
1
2
3
4
5
3.2 Where our services delivered in a culturally responsive manner?
*
1. Very Well – 5. Poor
1
2
3
4
5
3.3 Did our facilities enable you to access the service(s) with ease?
*
1. Very Well – 5. Poor
1
2
3
4
5
Comments
3.4 Would you recommend this service to your whānau?
1. Very Well – 5. Poor
Yes
No
3.5 Would you utilise this service again?
1. Very Well – 5. Poor
Yes
No
Name
This field is for validation purposes and should be left unchanged.