KoaHanii Disability Mental Health Services Pty Ltd FeedBack Form

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KoaHanii Disability and mental Health Services Pty Ltd (KHDMHS) participant feedback form.

If you are writing from your experiences with an NDIS participant in our service please provide this information, alternatively please enter your details in place of participant details, where it states "participant #" please enter your contact number if you wish to be contacted in relation to this form, otherwise if you wish to remain anonymous please write "anonymous" in both sections.

Date(s) of interaction is mandatory, along with a brief explanation.

Participant Name *

Please include the participant number and the date(s) of interaction

How would you rate your overall experience with KHDMHS as an NDIS service provider? (Please rate on a scale of 1 to 5, with 5 being the highest) *

Bottom Line Industry Standards

Above & Beyond Industry Standards

Please provide details about the specific services you received from KHDMHS.

Assistance with Daily Living

Community Access and Social / Civic Participation

Support Coordination

Respite

Short-Term Accomodation

Supported Learning / Educational Services

Mentoring

Recovery / Peer Coaching

Life Transition / Planning

Palliative

Other:

Were the services provided by KHDMHS aligned with your NDIS plan and goals?
*

Yes

Please elaborate on the previous question - Were the services provided by KHDMHS aligned with your NDIS plan and goals?
*

How would you rate the communication and responsiveness of the staff at KHDMHS?
*

Minimal Responsiveness

Exceptional Responsiveness

Did the staff at KHDMHS treat you with respect and dignity throughout your engagement? *

Yes

Please share any relevant experiences on the previous question - Did the staff at KHDMHS treat you with respect and dignity throughout your engagement?
*

Were you satisfied with the quality of the services provided by KHDMHS? *

Yes

If you answered no to the previous question, please specify the areas of improvement.

Did KHDMHS promptly address any concerns or issues you raised during your engagement with them?
*

Yes

Please provide details on the previous question - Did KHDMHS promptly address any concerns or issues you raised during your engagement with them? *

Were the staff at KHDMHS knowledgeable and competent in delivering the services you required?

Yes

Clear selection

Did KHDMHS consistently adhere to the agreed-upon schedule and appointments?

Yes

Other:

Clear selection

Would you recommend KHDMHS to other NDIS participants? Why or why not?

Is there anything specific that KHDMHS can do to improve its services or enhance the participant experience?
*

Thank you for taking the time to provide feedback. Your input is valuable to us and will help us enhance our services for the benefit of all NDIS participants.

Please provide any additional comments or feedback regarding your experience with KHDMHS.

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