Adult Carers Services Feedback Form Question Title * 1. Have you accessed any of the services listed below in the last year? (tick all that apply) Carers Assessments / Support Plans Counselling Services Legal Advice Art Class Cherry Lodge Cancer Group Mindfulness Sessions Form Filling Creative Writing Dementia Service Manual Handling Training Mental Health Support Groups Coffee Mornings / Drop-Ins Other (please specify) Question Title * 2. Do you feel as though the support you have received from the Centre is relevant to you / has helped you cope better in your caring role Yes No If no, please say why. Question Title * 3. Do you feel that your enquiries, questions and suggestions are taken into consideration by Barnet Carers Centre? Yes No If no, please say why. Question Title * 4. Do you feel that the services we provide are tailored to your specific needs? Yes No If no, please say why. Question Title * 5. Do you feel as though the support that you have received from the Centre has made a positive contribution to your ability to maintain your own health and well-being? Yes No If no, please say why. Question Title * 6. Do you feel as though the support you have received has contributed towards you maintaining positive relationships with friends and family? Yes No If no, please say why. Question Title * 7. Are you better able to self-manage / manage resources as a result of the support you have received? Yes No If no, please say why. Question Title * 8. On a scale of 1 to 5, how would you rate the effectiveness of the services offered by Barnet Carers Centre? (1 being ineffective and 5 being very effective) 1 3 5 Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 9. If you rated our service effectiveness as under 2 could you please tell us why and suggest ways in which we could do better? Question Title * 10. Is there anything you feel that is missing that would have benefitted you in your caring role? Question Title * 11. We are currently reviewing our services to carers. Please indicate below what health and wellbeing services you might be interested in. Chair based pilates Instructor led exercise Light circuits Stretch and relax Enerchi (fitness based Tai Chi) Dancersise Boxercise Stress relief Mindfulness Holistic health Monthly health talk Other (please specify) Question Title * 12. We are currently reviewing our services to carers. Please indicate below what practical services you might be interested in. Employment support (getting back into employment) Form filling Legal support (power of attorney etc.) Benefits advice Counselling Other (please specify) Question Title * 13. We are currently reviewing our services to carers. Please indicate below what social or entertainment services you might be interested in. Art Class (with an art teacher/facilitator) Keep Calm and Sing Creative Writing Book Club Other (please specify) Question Title * 14. We are currently reviewing our services to carers. Please indicate below what peer support services you might be interested in Cancer care (for those caring for someone with cancer) Mental health (for those caring for someone with mental health problems) Dementia care (for those caring for someone with dementia) Other (please specify) Question Title * 15. We are currently reviewing our services to carers. We are considering introducing a mentoring programme where you might get support from someone with specific knowledge or who has been in a similar situation to you. Would you be interested in the following: Mentoring face-to-face Mentoring via the telephone Mentoring online Not interested Question Title * 16. Would you be interested in helping Barnet Carers Centre develop and design its services for carers? Yes No Question Title * 17. If you would like us to reply to any of your questions or would like a copy of the final results please leave us your email address. Name Email Address Done
