Survey Form

Kindly fill out the details

Name *

Email *

I am completing this survey as:

Consumer or service user or person seeking support. Family, whanau or friend Not sure

Thinking about your most recent experience with the service/people who support you how much do you agree or disagree with the following statement

Worst Poor Average Good Excellent

I am involved in decision making:

Worst Poor Average Good Excellent

My family/Whanau are given information and encouraged to be involved:

Worst Poor Average Good Excellent

The people I see communicate with each other when I need them to:

Worst Poor Average Good Excellent

I have the support I need for the future:

Worst Poor Average Good Excellent

Our plan is reviewed regularly:

Worst Poor Average Good Excellent

I would recommend this service to friends and family/whanau if they needed similar care or treatment:

Worst Poor Average Good Excellent

I would recommend this service to friends and family/whanau if they needed similar care or treatment:

Worst Poor Average Good Excellent

How well did you feel Kaitautoko respected your values and beliefs:

How often did you see whakawanaungatanga used when accessing our service:

Never Occasionally Sometimes Mostly Almost always

How often were you shown manaakitanga from Kaitautoko providing your service:

Never Occasionally Sometimes Mostly Almost always

Would you like to more Te Ao Maori activities delivered within Te Waka Whaiora:

A lot more Slightly more No, you’ve got it just right

What ethnic group/s do you belong to?

New Zealand European Maori Samoan Cook Island Maori Tongan Niuean Chinese Indian Other

What age range do you belong to?

1-11 Years 12-19 Years 20-24 Years 25-34 Years 35-44 Years 45-54 Years Above 55 Years

Is there anything you want to say about your recent experience with the service or anything you think we can improve on?

By S-net. 2023