In Work Support Service – Client Evaluation

Client Name

Date of birth

Client ID

Delivery Provider RCS

New Field New Field We would greatly appreciate you taking a few minutes to complete this feedback form. Your feedback is very important to us and will help us to continue improving our services. hide

New Field New Field In-Work Support Service Evaluation Questions hide

New Field New Field Please answer the following questions thinking about the service you have received from the In-Work Support Service by placing a tick in the corresponding box, 5 is the highest score (excellent) and 1 is the lowest (not satisfactory). hide

1. How do you rate the initial contact with the In-Work Support Service? 1. How do you rate the initial contact with the In-Work Support Service? 1 2 3 4 5

2. How do you rate the support you received from the In-Work Support Service? 2. How do you rate the support you received from the In-Work Support Service? 1 2 3 4 5

3. How do you rate the timescales in which you were seen by the service? 3. How do you rate the timescales in which you were seen by the service? 1 2 3 4 5

4. How do you rate your overall impression of the In-Work Support Service? 4. How do you rate your overall impression of the In-Work Support Service? 1 2 3 4 5

5. How happy would you feel to recommend the In-Work Support Service to others? 5. How happy would you feel to recommend the In-Work Support Service to others? 1 2 3 4 5

6. Did the In-Work Support Service help you to stay in work or return to work quicker than if you had not had the support? 6. Did the In-Work Support Service help you to stay in work or return to work quicker than if you had not had the support? 1 2 3 4 5

SERVICE COMMENTS 7. Do you have any comments you would like to make? These can be made in the box below, or if you prefer, you can e-mail us at clientadmin@rcs-wales.co.uk

New Field New Field Therapist Evaluation Questions hide

New Field New Field Please answer the following questions thinking about the therapeutic intervention you have received. Please insert a tick in the box that best corresponds with the answer with 5 being the highest score (excellent) and 1 being the lowest score (not satisfactory). hide

1. How do you rate the overall experience from your therapist / provision? 1. How do you rate the overall experience from your therapist / provision? 1 2 3 4 5

2. How would you rate their friendliness, knowledge and willingness to help? 2. How would you rate their friendliness, knowledge and willingness to help? 1 2 3 4 5

3. How would you rate the advice / treatment you were given? 3. How would you rate the advice / treatment you were given? 1 2 3 4 5

4. How satisfied are you with the result of your intervention? 4. How satisfied are you with the result of your intervention? 1 2 3 4 5

5. On average approximately how long did your sessions usually last? 5. On average approximately how long did your sessions usually last? Up to 30 minutes Up to 45 minutes Up to 60 minutes Up to 75 minutes Longer than 75 minutes

6. Were your sessions usually interruption free? 6. Were your sessions usually interruption free? Yes No

7. Did you feel comfortable in the premises your treatment was provided in? 7. Did you feel comfortable in the premises your treatment was provided in? Yes No

8. Would you recommend this service to others (work colleagues, family and friends)? 8. Would you recommend this service to others (work colleagues, family and friends)? Yes No

THERAPIST COMMENTS 9. Do you have any comments you would like to make? Please enter your comments below: