GROUP THERAPY FEEDBACK FORM

At Potential Therapy Services for Children, we work hard to provide a holistic, family centred service which makes a sustainable difference in your child’s life. Based on your child's recent attendence to a group at Potential Therapy Services, we would appreciate you taking the time to complete this survey to help us better understand how we can provide the best possible service for your family. PLEASE NOTE: This survey does not require all questions to be answered, so if you would like your feedback to remain anonymous or you would prefer not to answer some of the questions, please leave those fields blank.

First Name

Last Name

How did you hear about us?

GP Referral

NDIS Provider Finder

Friends or family

Child's school

Social media

Internet search

Community service such as People's Place Busselton

Were your expectations...

Met

Unmet

Exceeded

The overall service provided at Potential represents value for money.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree

The intervention provided from Potential made a positive functional difference in our child and our family’s life.

Strongly Disagree

Disagree

Neutral

Agree

Strongly Agree