Feedback form (Norwich)

1. Client satisfaction survey

At Sue Lambert Trust, we are always striving to improve our services. It would really help us if you could find the time to fill in this survey.

1. What services have you accessed at the Sue Lambert Trust? *

Counselling service
Support worker service
Groups

2. What was the name of your counsellor / support worker? *

3. Please circle the number which best indicates how you agree or disagree with each statement. *

	Strongly agree	Agree	Disagree	Strongly disagree	Neither or N/A
I felt supported whilst I was on the waiting list for counselling	I felt supported whilst I was on the waiting list for counselling Strongly agree	I felt supported whilst I was on the waiting list for counselling Agree	I felt supported whilst I was on the waiting list for counselling Disagree	I felt supported whilst I was on the waiting list for counselling Strongly disagree	I felt supported whilst I was on the waiting list for counselling Neither or N/A
I felt listened to at the Sue Lambert Trust	I felt listened to at the Sue Lambert Trust Strongly agree	I felt listened to at the Sue Lambert Trust Agree	I felt listened to at the Sue Lambert Trust Disagree	I felt listened to at the Sue Lambert Trust Strongly disagree	I felt listened to at the Sue Lambert Trust Neither or N/A
Sue Lambert's staff and volunteers were professional	Sue Lambert's staff and volunteers were professional Strongly agree	Sue Lambert's staff and volunteers were professional Agree	Sue Lambert's staff and volunteers were professional Disagree	Sue Lambert's staff and volunteers were professional Strongly disagree	Sue Lambert's staff and volunteers were professional Neither or N/A
Sue Lambert's staff and volunteers were supportive and caring	Sue Lambert's staff and volunteers were supportive and caring Strongly agree	Sue Lambert's staff and volunteers were supportive and caring Agree	Sue Lambert's staff and volunteers were supportive and caring Disagree	Sue Lambert's staff and volunteers were supportive and caring Strongly disagree	Sue Lambert's staff and volunteers were supportive and caring Neither or N/A
I found the support offered by the Sue Lambert Trust helpful	I found the support offered by the Sue Lambert Trust helpful Strongly agree	I found the support offered by the Sue Lambert Trust helpful Agree	I found the support offered by the Sue Lambert Trust helpful Disagree	I found the support offered by the Sue Lambert Trust helpful Strongly disagree	I found the support offered by the Sue Lambert Trust helpful Neither or N/A
I would use this service again if needed	I would use this service again if needed Strongly agree	I would use this service again if needed Agree	I would use this service again if needed Disagree	I would use this service again if needed Strongly disagree	I would use this service again if needed Neither or N/A
I would recommend this service to a family member or friend	I would recommend this service to a family member or friend Strongly agree	I would recommend this service to a family member or friend Agree	I would recommend this service to a family member or friend Disagree	I would recommend this service to a family member or friend Strongly disagree	I would recommend this service to a family member or friend Neither or N/A

4. Did you find receiving support from the Sue Lambert Trust helped you in any of the following areas? *

	Yes	No	Not relevant or applicable
Increased emotional wellbeing	Increased emotional wellbeing Yes	Increased emotional wellbeing No	Increased emotional wellbeing Not relevant or applicable
Improved coping resources	Improved coping resources Yes	Improved coping resources No	Improved coping resources Not relevant or applicable
Increased self-esteem	Increased self-esteem Yes	Increased self-esteem No	Increased self-esteem Not relevant or applicable
Improved day-to-day living (e.g. ability to carry out everyday tasks, sleeping)	Improved day-to-day living (e.g. ability to carry out everyday tasks, sleeping) Yes	Improved day-to-day living (e.g. ability to carry out everyday tasks, sleeping) No	Improved day-to-day living (e.g. ability to carry out everyday tasks, sleeping) Not relevant or applicable
Reduced suicidal thoughts or feel more able to manage these	Reduced suicidal thoughts or feel more able to manage these Yes	Reduced suicidal thoughts or feel more able to manage these No	Reduced suicidal thoughts or feel more able to manage these Not relevant or applicable
Improved relationships with family and/or friends	Improved relationships with family and/or friends Yes	Improved relationships with family and/or friends No	Improved relationships with family and/or friends Not relevant or applicable
Getting into/maintaining employment	Getting into/maintaining employment Yes	Getting into/maintaining employment No	Getting into/maintaining employment Not relevant or applicable
Reduced use of other mental health services and/or hospital admissions	Reduced use of other mental health services and/or hospital admissions Yes	Reduced use of other mental health services and/or hospital admissions No	Reduced use of other mental health services and/or hospital admissions Not relevant or applicable

5. Finally, during your counselling you may have completed a form about how you were feeling. This final part of the form has 10 statements about how you have been OVER THE LAST WEEK. Please read each statement and think how often you felt that way last week. Then tick the box which is closest to this.

Please note that these forms are not processed every day and we are unable to identify individuals from these forms. Therefore, if you are feeling low and need some support then please remember there are people you can talk to such as the Samaritans (Tel: 116 123).

Over the last week ...

	Not at all	Only occasionally	Sometimes	Often	Most or all of the time
1) I have felt tense, anxious or nervous	1) I have felt tense, anxious or nervous Not at all	1) I have felt tense, anxious or nervous Only occasionally	1) I have felt tense, anxious or nervous Sometimes	1) I have felt tense, anxious or nervous Often	1) I have felt tense, anxious or nervous Most or all of the time
2) I have felt I have someone to turn to for support when needed	2) I have felt I have someone to turn to for support when needed Not at all	2) I have felt I have someone to turn to for support when needed Only occasionally	2) I have felt I have someone to turn to for support when needed Sometimes	2) I have felt I have someone to turn to for support when needed Often	2) I have felt I have someone to turn to for support when needed Most or all of the time
3) I have felt able to cope when things go wrong	3) I have felt able to cope when things go wrong Not at all	3) I have felt able to cope when things go wrong Only occasionally	3) I have felt able to cope when things go wrong Sometimes	3) I have felt able to cope when things go wrong Often	3) I have felt able to cope when things go wrong Most or all of the time
4) Talking to people has felt too much for me	4) Talking to people has felt too much for me Not at all	4) Talking to people has felt too much for me Only occasionally	4) Talking to people has felt too much for me Sometimes	4) Talking to people has felt too much for me Often	4) Talking to people has felt too much for me Most or all of the time
5) I have felt panic or terror	5) I have felt panic or terror Not at all	5) I have felt panic or terror Only occasionally	5) I have felt panic or terror Sometimes	5) I have felt panic or terror Often	5) I have felt panic or terror Most or all of the time
6) I have made plans to end my life	6) I have made plans to end my life Not at all	6) I have made plans to end my life Only occasionally	6) I have made plans to end my life Sometimes	6) I have made plans to end my life Often	6) I have made plans to end my life Most or all of the time
7) I have had difficulty getting to sleep or staying asleep	7) I have had difficulty getting to sleep or staying asleep Not at all	7) I have had difficulty getting to sleep or staying asleep Only occasionally	7) I have had difficulty getting to sleep or staying asleep Sometimes	7) I have had difficulty getting to sleep or staying asleep Often	7) I have had difficulty getting to sleep or staying asleep Most or all of the time
8) I have felt despairing or hopeless	8) I have felt despairing or hopeless Not at all	8) I have felt despairing or hopeless Only occasionally	8) I have felt despairing or hopeless Sometimes	8) I have felt despairing or hopeless Often	8) I have felt despairing or hopeless Most or all of the time
9) I have felt unhappy	9) I have felt unhappy Not at all	9) I have felt unhappy Only occasionally	9) I have felt unhappy Sometimes	9) I have felt unhappy Often	9) I have felt unhappy Most or all of the time
10) Unwanted images or memories have been distressing me	10) Unwanted images or memories have been distressing me Not at all	10) Unwanted images or memories have been distressing me Only occasionally	10) Unwanted images or memories have been distressing me Sometimes	10) Unwanted images or memories have been distressing me Often	10) Unwanted images or memories have been distressing me Most or all of the time

6. If you have any other feedback, please use the box below. Thank you for taking the time to complete this form. Your feedback is very much appreciated.

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