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Clatterbridge Cancer Centre Feedback Form

Page 1

Question 1.

Date of Session

Question 2.

Location e.g ward, waiting area

Question 3.

Did the session enable you to:

Interact with others?
Express thoughts, feelings or ideas?
Experience improved mood?
Experience reduced anxiety?
Question 4.

Did you notice any changes in the environment as a result of the session? E.g. positive/ calm/ relaxed atmosphere

Question 5.

Do you have any feedback or suggestions for future sessions?