Spread a Smile Feedback Questionnaire

Thank you so much for completing this questionnaire. We really appreciate you taking the time to do so. Please note that this is an anonymous survey and your answers will be used to help us improve our work and ensure that we are always providing the best possible services.

1. How old is your child? *


Please select	Please select

2. What is your child's condition? (Optional)

3. Which hospital has your child received treatment at? *

	.
Please Select	Please Select .

If you select other, please state which hospital

4. What is your home county? *


Please Select	Please Select

If selected other please state which county

5. How long has your child been receiving hospital treatment? *

6. Please tell us how you heard about Spread a Smile *

If selected other please comment here:

7. How many Spread a Smile virtual visits has your child received? *

0
1-4
5-10
10+

8. Please rate the following aspects of your interaction with Spread a Smile using the boxes below *

	Outstanding	Very Good	Good	Poor	Very Poor	Not Applicable
Professionalism of team prior to virtual visit	Professionalism of team prior to virtual visit Outstanding	Professionalism of team prior to virtual visit Very Good	Professionalism of team prior to virtual visit Good	Professionalism of team prior to virtual visit Poor	Professionalism of team prior to virtual visit Very Poor	Professionalism of team prior to virtual visit Not Applicable
Professionalism of team post virtual visit	Professionalism of team post virtual visit Outstanding	Professionalism of team post virtual visit Very Good	Professionalism of team post virtual visit Good	Professionalism of team post virtual visit Poor	Professionalism of team post virtual visit Very Poor	Professionalism of team post virtual visit Not Applicable
Communication with team prior to virtual visit	Communication with team prior to virtual visit Outstanding	Communication with team prior to virtual visit Very Good	Communication with team prior to virtual visit Good	Communication with team prior to virtual visit Poor	Communication with team prior to virtual visit Very Poor	Communication with team prior to virtual visit Not Applicable
Communication with team post virtual visit	Communication with team post virtual visit Outstanding	Communication with team post virtual visit Very Good	Communication with team post virtual visit Good	Communication with team post virtual visit Poor	Communication with team post virtual visit Very Poor	Communication with team post virtual visit Not Applicable
Quality of entertainment on virtual visit(s)	Quality of entertainment on virtual visit(s) Outstanding	Quality of entertainment on virtual visit(s) Very Good	Quality of entertainment on virtual visit(s) Good	Quality of entertainment on virtual visit(s) Poor	Quality of entertainment on virtual visit(s) Very Poor	Quality of entertainment on virtual visit(s) Not Applicable
Online safety during virtual visit	Online safety during virtual visit Outstanding	Online safety during virtual visit Very Good	Online safety during virtual visit Good	Online safety during virtual visit Poor	Online safety during virtual visit Very Poor	Online safety during virtual visit Not Applicable
Overall experience of virtual visit	Overall experience of virtual visit Outstanding	Overall experience of virtual visit Very Good	Overall experience of virtual visit Good	Overall experience of virtual visit Poor	Overall experience of virtual visit Very Poor	Overall experience of virtual visit Not Applicable

9. How could we improve Spread a Smile virtual visits?

10. Aside from Virtual Visits, what services are you aware of that Spread a Smile offers?
(Tick all that apply) *

11. Please tell us about the impact Spread a Smile services have had on your child.
*

12. Please tell us about the impact Spread a Smile services have had on any siblings.

13. How much do you agree or disagree with the following statements about Spread a Smile's Virtual Visits? *

	Strongly Agree	Agree	Not sure	Disagree	Strongly Disagree	Not applicable
They provide a distraction from treatment	They provide a distraction from treatment Strongly Agree	They provide a distraction from treatment Agree	They provide a distraction from treatment Not sure	They provide a distraction from treatment Disagree	They provide a distraction from treatment Strongly Disagree	They provide a distraction from treatment Not applicable
They reduce pain and/or anxiety	They reduce pain and/or anxiety Strongly Agree	They reduce pain and/or anxiety Agree	They reduce pain and/or anxiety Not sure	They reduce pain and/or anxiety Disagree	They reduce pain and/or anxiety Strongly Disagree	They reduce pain and/or anxiety Not applicable
They improve compliance with treatment and/or procedures	They improve compliance with treatment and/or procedures Strongly Agree	They improve compliance with treatment and/or procedures Agree	They improve compliance with treatment and/or procedures Not sure	They improve compliance with treatment and/or procedures Disagree	They improve compliance with treatment and/or procedures Strongly Disagree	They improve compliance with treatment and/or procedures Not applicable
They help boost confidence and self-esteem	They help boost confidence and self-esteem Strongly Agree	They help boost confidence and self-esteem Agree	They help boost confidence and self-esteem Not sure	They help boost confidence and self-esteem Disagree	They help boost confidence and self-esteem Strongly Disagree	They help boost confidence and self-esteem Not applicable
They encourage socialisation and help connect with others	They encourage socialisation and help connect with others Strongly Agree	They encourage socialisation and help connect with others Agree	They encourage socialisation and help connect with others Not sure	They encourage socialisation and help connect with others Disagree	They encourage socialisation and help connect with others Strongly Disagree	They encourage socialisation and help connect with others Not applicable
They create positive memories	They create positive memories Strongly Agree	They create positive memories Agree	They create positive memories Not sure	They create positive memories Disagree	They create positive memories Strongly Disagree	They create positive memories Not applicable
They make the hospital environment seem less frightening/scary	They make the hospital environment seem less frightening/scary Strongly Agree	They make the hospital environment seem less frightening/scary Agree	They make the hospital environment seem less frightening/scary Not sure	They make the hospital environment seem less frightening/scary Disagree	They make the hospital environment seem less frightening/scary Strongly Disagree	They make the hospital environment seem less frightening/scary Not applicable
They improve the hospital experience	They improve the hospital experience Strongly Agree	They improve the hospital experience Agree	They improve the hospital experience Not sure	They improve the hospital experience Disagree	They improve the hospital experience Strongly Disagree	They improve the hospital experience Not applicable
They have a positive impact on emotional well being	They have a positive impact on emotional well being Strongly Agree	They have a positive impact on emotional well being Agree	They have a positive impact on emotional well being Not sure	They have a positive impact on emotional well being Disagree	They have a positive impact on emotional well being Strongly Disagree	They have a positive impact on emotional well being Not applicable
They are tailored appropriately to age/developmental level	They are tailored appropriately to age/developmental level Strongly Agree	They are tailored appropriately to age/developmental level Agree	They are tailored appropriately to age/developmental level Not sure	They are tailored appropriately to age/developmental level Disagree	They are tailored appropriately to age/developmental level Strongly Disagree	They are tailored appropriately to age/developmental level Not applicable
Spread a Smile takes the time to understand individual needs	Spread a Smile takes the time to understand individual needs Strongly Agree	Spread a Smile takes the time to understand individual needs Agree	Spread a Smile takes the time to understand individual needs Not sure	Spread a Smile takes the time to understand individual needs Disagree	Spread a Smile takes the time to understand individual needs Strongly Disagree	Spread a Smile takes the time to understand individual needs Not applicable

14. Would you recommend Spread a Smile based on your experience?

	Very likely	Likely	Neither likely nor unlikely	Unlikely	Very unlikely
Please select	Please select Very likely	Please select Likely	Please select Neither likely nor unlikely	Please select Unlikely	Please select Very unlikely

15. What is your view of Spread a Smile?

16. Which three words do you think best describe Spread a Smile?

17. Please share any other comments or feedback with us about the impact of our work or to help us improve

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