Hauora Feedback Form

Whānau Evaluation Form

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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
Phone
This field is for validation purposes and should be left unchanged.

Whānau Evaluation Form

Whānau Evaluation Form

1. Huria Trust Hauora Service(s)

2. Huria Trust Kaiāwhina

3. Overall