Keeping Well Feedback Survey

Thank you for taking part in this survey. We would love to hear about your experience of Keeping Well, the NHS and care staff support service for North West London.

This service is a collaboration between Back on Track (Hammersmith and Fulham), Ealing, Hounslow, Brent, Harrow, Hillingdon, Westminster and Community Living Well (Kensington and Chelsea) Improving Access to Psychological Therapies (IAPT) services.

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* 1. How did you hear about the service?

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* 2. Why did you contact the service?

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* 3. Is/Was the service helpful to you? Please explain your answer

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* 4. Would you be happy for the Keeping Well service to use your recent experience as part of a promotional case study or a testimonial for our website?

Yes

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* 5. If yes, please enter how you would prefer to be known (this could be full name / first name / a nickname or anonymous)

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* 6. Would you be willing to have your photo taken or appear in a video talking about your experience?

Yes

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* 7. Please enter your name, telephone, email if you are happy for us to contact you for further information or to have a photo taken or appear in a video

Name

Email Address

Phone Number

Keeping Well Feedback Survey

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* 1. How did you hear about the service?

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* 2. Why did you contact the service?

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* 3. Is/Was the service helpful to you? Please explain your answer

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* 4. Would you be happy for the Keeping Well service to use your recent experience as part of a promotional case study or a testimonial for our website?

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* 5. If yes, please enter how you would prefer to be known (this could be full name / first name / a nickname or anonymous)

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* 6. Would you be willing to have your photo taken or appear in a video talking about your experience?

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* 7. Please enter your name, telephone, email if you are happy for us to contact you for further information or to have a photo taken or appear in a video

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* 8. Are you happy to share with us where you work and your job role? If so please add below