(To be completed at the end of first call)

At Age NI we are always striving to develop our services, to make sure we are meeting the needs of the people who use them. You can help us with this by answering the short questionnaire below. The information you provide will help us with service development, to advertise the benefits of the service,
to report to funders and to inform policy.

Your Data Security and Confidentiality
Your data will be stored in a secure database and will be used only for the purposes of this service.  You will never be contacted by Age NI for marketing purposes, unless you have previously indicated this as a preference.
Only the Impact & Evaluation Manager will access your responses, for analysis and research purposes. Your data will not be shared with any third parties.

Your Rights
You have the right to withdraw consent at anytime by contacting Age NI by email; info@ageni.org or telephone; 028 90 245729 or by speaking to the service manager.  
If consent is withdrawn it will not impact the support you receive in any way.

How Long Do we hold your Data
All client data is held for 8 years from the closing date of the record for legal and business purposes.

We would like to know about your experience with our service. Please select the answer closest to how you feel for each question.

Thank you for your time.

Question Title

* 1. Please ensure you have read the information above outlining how the data we collect will be stored and used. Once you have read this, please indicate below if you understand and agree to how your information will be used:

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