Well-Being Video Feedback Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for watching our video, we would love some feedback if you could spare us a few moments.

Age of your youngest child?

up to 12 months

13-24 months

25-36 months

2-3 years

over 3 years

Clear selection

How would you rate your mental health?

Very good

Good

Poor

Very Poor

Prefer not to say

Clear selection

What did you like about the video?

You might like to talk about its presentation, the characters, what was said, how it made you feel, the content, or any other comments.

What did you not like so much about the video?

You might like to talk about its presentation, the characters, what was said, how it made you feel, the content, or any other comments.

How helpful did you find the suggestions for how you can look after yourself?

very helpful

a little helpful

not helpful

Slowing down

Keeping up with the basics

Doing something you enjoy

Moving your body

Getting outside

Being in the sunlight

Resting

Spending time focusing on your baby

Talking to family/friends/other parents

Talking to professionals such as GP, midwife or health visitor

If applicable, which suggestion did you find helpful in particular?

If applicable, was there anything that you felt was unhelpful about the video?

Has this video raised your awareness of the importance of your mental well-being as a parent for your baby?

Yes

Already aware

Clear selection

Do you feel that you have been given any ideas about how to improve your mental well-being while looking after your baby?

Yes

Clear selection

If yes, what will you start or do differently after watching this video?

What is your gender?

Male

Female

Other

Clear selection

What is your age?

12-17 years

18-24 years

25-34 years

35-44 years

45-54 years

Other

Clear selection

What is your ethnicity?

Asian or Asian British: Indian

Asian or Asian British: Pakistani

Asian or Asian British: Bangladeshi

Asian or Asian British: Chinese

Any other Asian background

Black, Black British, Caribbean or African: Caribbean

Black, Black British, Caribbean or African: African

Any other Black, Black British, Caribbean background

Mixed or multiple ethnic groups: White and Black Caribbean

Mixed or multiple ethnic groups: White and Black African

Mixed or multiple ethnic groups: White and Asian

Any other Mixed or multiple ethnic background

White English, Welsh,Scottish, Northern Irish or British

White Irish

White Gypsy or Irish Traveller

White Roma

Any other White background

Arab

Any other ethnic group

Clear selection

What is the first half of your postcode?

If you're happy to be added to the Close-Knit mailing list, and to be in with the chance to win a £20 amazon voucher, please add your email address here

Would you have a quote about the work of Close-Knit for us to use in future marketing? If so, please add the quote and your name in a way you would be comfortable for it to be displayed- i.e initials/full name/first name/anon

THANK YOU FOR YOUR TIME AND FEEDBACK IT WILL HELP US TO EVALUATE OUR WORK AND WHEN MAKING FUTURE RESOURCES.

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms