Compliments, Complaints and Feedback

We value your opinion about your experiences with us. Completeting this survey is voluntary and will not affect the care you receive. You do not have to complete this survey, but we hope that you will. Your feedback will help us review and improve our service. Please complete the survey below: @media screen and (max-width: 480px) { .wdform-field-section-break { max-width: 220px !important; } .wdform_page { padding: 0 !important; } .wdform-element-section { max-width: 285px; min-width: 150px !important; } div[type="type_editor"]{ max-width: 280px; } .wdform-field{ max-width: 285px; } } @media screen and (min-width: 481px) and (max-width: 768px) { div[type="type_editor"]{ max-width:480px; } } .g-recaptcha >div { height: inherit !important; } #form13 .recaptcha_input_area input{height:initial !important;}#form13 a.ui-spinner-button{border-radius:0px !important;background: none!important;}#form13 a.ui-slider-handle {width: 8px;height: 8px;top: -4px;border: 0px;border-radius: 13px;background: #FAFAFA;border: 3px solid #B1B1B1;outline: none;}#form13 .ui-slider { height: 6px; background: #F5F5F5 !important; margin: 7px 0px;}#form13 .wdform_grading input { width: 100px;}#form13 .wdform-matrix-cell input[type="text"] { width: 100px;}#form13 .wdform-matrix-cell select { width: 60px;}#form13 .wdform_section .wdform_column:last-child { padding-right: 0px !important;}#form13 .wdform_preload { display: none;}#form13 .wdform_grading { padding: 3px 0px;}#form13 .wdform-matrix-table { display: table; border-spacing: 0px;}#form13 .wdform-matrix-column { text-align: left; display: table-cell;}#form13 .wdform-matrix-cell { text-align: center; display: table-cell; padding: 6px 10px;}#form13 .wdform-matrix-head>div { display: table-cell; text-align: center;}#form13 .wdform-matrix-head { display: table-row;}#form13 .wdform-matrix-row0 { background: #DFDFDF; display: table-row;}#form13 .wdform-matrix-row1 { background: #E9E9E9; display: table-row;}#form13 .selected-text { text-align: left; color: #000;}#form13 .wdform-quantity { width: 30px; margin: 2px 0px;}#form13 .wdform_scale_rating label { vertical-align: middle;}#form13 .ui-corner-all { border-radius: 0px;}#form13 .ui-widget-content { border: 0px; background: transparent;}#form13 .ui-slider-range { background: #8A8A8A !important;}#form13 .wdform_map { border: 6px solid #fff;}#form13 .wdform-page-and-images { width: 100%;border-top: 1px solid #7F7F7F !important;}#form13 .paypal-property { display: inline-block; margin-right: 15px; vertical-align: middle;}#form13 .sel-wrap { display: inline-block; vertical-align: middle; width:100%;}#form13 .sel-wrap select { position: absolute; z-index:-1; width: 0px !important;}#form13 .sel-imul { display: inline-block;}#form13 .sel-imul .sel-selected { cursor: pointer; position: relative; display: inline-block; border-radius: 0px; padding: 0px 0px 0px 2px; font-size: 13px; height: 22px; line-height: 22px; overflow: hidden; background: #F8F8F8;border: 1px solid #B7B7B7; background-position: right 2px center; width: 100%;}#form13 .sel-imul.act .sel-selected { background: #fff;}#form13 .sel-selected .sel-arraw { height: 23px; width: 30px; background: url(/components/com_formmaker/images/09/01.png) 50% 50% no-repeat; position: absolute; top: 0px; right: 0px; padding: 0px;}#form13 .sel-imul:hover .sel-selected .sel-arraw {// background-color:#e0e0e0;// border-left:1px solid #bbb;}#form13 .sel-imul.act .sel-selected .sel-arraw {// background-color:#e0e0e0;// border-left:1px solid #bbb;}#form13 .sel-imul .sel-options { background: #fff; border: 1px solid #dbdbdb; border-top: none; position: absolute; width: inherit; display: none; z-index: 10; max-height: 200px; overflow-y: auto; overflow-x: hidden;}#form13 .sel-options .sel-option { padding: 3px 4px; font-size: 13px; border: 1px solid #fff; border-right: none; border-left: none; text-align: left;}#form13 .sel-options .sel-option:hover { border-color: #dbdbdb; cursor: pointer;}#form13 .sel-options .sel-option.sel-ed { background: #dbdbdb; border-color: #dbdbdb;}#form13 input[type=text]{ margin: 0px;}#form13 input[type=password]{ margin: 0px;}#form13 input[type=url]{ margin: 0px;}#form13 input[type=email]{ margin: 0px;}#form13 input.text{ margin: 0px;}#form13 input.title{ margin: 0px;}#form13 textarea{ margin: 0px;}#form13 select { margin: 0px;}#form13 .form-error { border-color: red !important;}#form13 .form-error:focus { border-color: red !important;}#form13 .wdform-field { display: table-cell; padding: 5px 0px;}#form13 .wdform-label-section{ text-align: left; display: table-cell;}#form13 .wdform-element-section { text-align: left; display: table-cell; min-width: 150px;}#form13 .file-upload input { position: absolute; visibility: hidden;}#form13 .file-upload-status { margin-left: 10px; max-width: 200px; font-weight: bold; font-size: 16px; color: #888; position: absolute; border-radius: 0px; height: 23px; padding-left: 5px; padding-right: 5px; white-space: nowrap; overflow: hidden; }#form13 .file-picker { width: 41px; height: 32px; background: url(/components/com_formmaker/images/09/01/upload.png) no-repeat; display: inline-block;}#form13 .next-page div.wdform-page-button { color: #A2A2A2; cursor: pointer; display: inline-block; height: 35px; line-height: 32px; background: url(/components/com_formmaker/images/09/next.png) no-repeat right; padding: 0px 36px 0 20px; vertical-align: middle; font-size: 18px; border: 1px solid #CECECE;}#form13 .previous-page div.wdform-page-button { color: #A2A2A2; cursor: pointer; display: inline-block; height: 35px; line-height: 35px; background: url(/components/com_formmaker/images/09/previous.png) no-repeat left; padding: 0 20px 0 36px; vertical-align: middle; font-size: 18px; border: 1px solid #CECECE;}#form13 .button-submit { color: #ffffff; cursor: pointer; display: inline-block; line-height: 35px; background: #013D7C; padding: 0px 20px; vertical-align: middle; font-size: 18px; min-width: 80px; min-height: 35px; font-family: Segoe UI; border: 1px solid transparent; margin: 5px;}#form13 .button-reset { color: #787878; cursor: pointer; display: inline-block; line-height: 35px; background: #F0EFEF; padding: 0px 20px; vertical-align: middle; font-size: 18px; min-width: 80px; min-height: 35px; font-family: Segoe UI; float: right; border: 1px solid transparent; margin: 5px;}#form13 .wdform_page { background: #EEEEEE; padding: 15px; border-radius: 0px; font-family: Segoe UI;}#form13 .wdform_column { border-right: none !important; padding-right: 20px !important; float: left; border-spacing: 2px; border-collapse: separate !important;}#form13 .wdform_section_break2 { color: #013D7C; display: inline-block; text-align: left; font-size: 23px;margin: 16px 10px 40px 0px;}#form13 .wdform_section_break { color: #013D7C; font-size: 23px;margin: 16px 0px;}#form13 .wdform_section { display: inline-block;}#form13 select { border-radius: 0px; height: 24px; overflow: hidden; box-shadow: none;background: #F8F8F8;border: 1px solid #B7B7B7; outline: none;}#form13 input[type="text"]{ border-radius: 0px; height: 22px;padding:0 3px !important;box-shadow:none; background: #F8F8F8;border:1px solid #B7B7B7;}#form13 input[type="password"]{ border-radius: 0px; height: 22px;padding:0 3px !important;box-shadow:none; background: #F8F8F8;border:1px solid #B7B7B7;}#form13 textarea { border-radius: 0px; height: 22px;padding:0 3px !important;box-shadow:none; background: #F8F8F8;border:1px solid #B7B7B7;}#form13 input[type="text"]:focus{ outline: none;box-shadow:none;}#form13 input[type="password"]:focus{ outline: none;box-shadow:none;}#form13 textarea:focus{ outline: none;box-shadow:none;}#form13 .input_deactive { color: #999999; font-style: italic;}#form13 .input_active { color: #000000; font-style: normal;}#form13 .am_pm_select { width: 30px; vertical-align: middle;}#form13 .checkbox-div input[type=checkbox] { position : absolute; z-index: -1;}#form13 .checkbox-div { width: 13px; height: 12px; background: transparent; border: 1px solid #8B8B8B; border-radius: 0px; position: relative; display: inline-block;}#form13 .checkbox-div label {cursor: pointer;-ms-filter: "progid:DXImageTransform.Microsoft.Alpha(Opacity=0)";filter: alpha(opacity=0);opacity: 0;content: '';position: absolute;width: 13px;height: 9px;background: url(/components/com_formmaker/images/09/checkbox.png) no-repeat;border-radius: 0px;top: 1px;left: 2px;}#form13 .checkbox-div label:hover { -ms-filter: "progid:DXImageTransform.Microsoft.Alpha(Opacity=30)"; filter: alpha(opacity=30); opacity: 0.3;}#form13 .checkbox-div .wdform-ch-rad-label:hover { -ms-filter: "progid:DXImageTransform.Microsoft.Alpha(Opacity=30)"; filter: alpha(opacity=30); opacity: 0.3;}#form13 .wdform-ch-rad-label:hover + .checkbox-div label { -ms-filter: "progid:DXImageTransform.Microsoft.Alpha(Opacity=30)"; filter: alpha(opacity=30); opacity: 0.3;}#form13 .checkbox-div input[type=checkbox]:checked + label { -ms-filter: "progid:DXImageTransform.Microsoft.Alpha(Opacity=100)"; filter: alpha(opacity=100); opacity: 1;}#form13 .wdform-calendar-button { display:inline-block; background: transparent url(/components/com_formmaker/images/03/date.png) no-repeat; border: 0px; color: transparent; width: 22px; height: 22px; position: relative; left: -22px; vertical-align: top; outline: none;}#form13 .radio-div input[type=radio] { position : absolute; z-index: -1;}#form13 .forlabs { float: right; margin-right: 20px;}#form13 .radio-div { width: 13px; height: 12px; background: transparent; border: 1px solid #8B8B8B; border-radius: 0px; position: relative; display: inline-block; top: 2px;}#form13 .radio-div label { cursor: pointer; -ms-filter: "progid:DXImageTransform.Microsoft.Alpha(Opacity=0)"; filter: alpha(opacity=0); opacity: 0; content: ''; position: absolute; width: 9px; height: 8px; background: #8B8B8B; border-radius: 0px; top: 2px; left: 2px;}#form13 .radio-div label:hover { -ms-filter: "progid:DXImageTransform.Microsoft.Alpha(Opacity=30)"; filter: alpha(opacity=30); opacity: 0.3;}#form13 .radio-div .wdform-ch-rad-label:hover { -ms-filter: "progid:DXImageTransform.Microsoft.Alpha(Opacity=30)"; filter: alpha(opacity=30); opacity: 0.3;}#form13 .wdform-ch-rad-label:hover + .radio-div label { -ms-filter: "progid:DXImageTransform.Microsoft.Alpha(Opacity=30)"; filter: alpha(opacity=30); opacity: 0.3;}#form13 .radio-div input[type=radio]:checked + label { -ms-filter: "progid:DXImageTransform.Microsoft.Alpha(Opacity=100)"; filter: alpha(opacity=100); opacity: 1;}#form13 .if-ie-div-label { -ms-filter: "progid:DXImageTransform.Microsoft.Alpha(Opacity=100)" !important; filter: alpha(opacity=100) !important; opacity: 1 !important;}#form13 .wdform-ch-rad-label { display: inline; margin-right:5px; float: left; color: #000; cursor: pointer}#form13 textarea { padding-top: 5px;}#form13 .wdform-date { display:inline-block; width: 105px}#form13 .wdform_footer { margin-top: 15px;}#form13 .page-numbers { vertical-align: middle;}#form13 .time_box { text-align: right; width: 30px; vertical-align: middle}#form13 .mini_label { font-size: 10px; font-family: 'Lucida Grande', Tahoma, Arial, Verdana, sans-serif; color: #8A8A8A;}#form13 .wdform-label { border: none; color: #000; vertical-align: top; line-height: 17px;}#form13 .wdform_colon { color: #000}#form13 .wdform_separator { font-style: bold; vertical-align: middle; color: #000;}#form13 .wdform_line { color: #000}#form13 .wdform-required { border: none; color: red; vertical-align: top;}#form13 .captcha_img { border-width: 0px; margin: 0px; padding: 0px; cursor: pointer; border-radius: 0px;}#form13 .captcha_refresh { width: 30px; height: 30px; border-width: 0px; margin: 0px; padding: 0px; vertical-align: middle; cursor: pointer; background-image: url(/components/com_formmaker/images/refresh_black.png);}#form13 .captcha_input { height: 20px; border-width: 1px; margin: 0px; padding: 0px; vertical-align: middle;}#form13 .file_upload { border: 0px solid white; border-radius: 0px; margin: 0px; padding: 0px; color: black; background-color: white;}#form13 .page_deactive {color: #808080;background-color: #E5E5E5;cursor: pointer;display: inline-block;height: 27px;text-align: center;vertical-align: bottom;padding: 5px 25px 0px 25px;font-size: 22px;margin-left:3px;margin-bottom:2px;}#form13 .page_active { color: #C2C2C2;cursor: pointer;background-color: #FFFFFF;display: inline-block;vertical-align: bottom;height: 29px;text-align: center;font-size: 22px;padding: 5px 25px 0px 25px;border: 1px solid #7F7F7F;margin-left:3px;margin-bottom: -1px;border-bottom: none;line-height: 26px;}#form13 .page_percentage_active {padding: 0px;border-spacing: 0px;height: 10px;background: #727272;float: left;}#form13 .page_percentage_deactive {height: 10px;line-height: 20px;background-color: #E5E5E5;text-align: left !important;margin-bottom: 2px;}#form13 .page_numbers { font-size: 14px; color: #000;}#form13 .phone_area_code { width: 50px;}#form13 .phone_number { width: 100px;}#form13 button { cursor: pointer;}#form13 .other_input { border-radius: 0px; border-width: 1px; height: 16px; font-size: 12px; padding: 1px; margin: 1px; margin-left: 25px; z-index: 100; position: absolute;}#form13 .wdform_page_navigation { text-align: right !important;}#form13 .wdform_percentage_text {color: #fff;font-size: 12px;position: relative;background: url(/pordznakan/components/com_formmaker/images/09/01/02.png) no-repeat;width: 36px;display: inline-block;height: 36px;top: -37px;left: 17px;text-align: center;line-height: 27px;float: right;}#form13 .wdform_percentage_title { color: #000000; font-style: italic; margin: 0px 0px 0px 40px; display: inline-block; line-height: 20px; height: 20px; vertical-align: middle;}#form13 .wdform_button button { background: #4D792C; cursor: pointer; font-size: 17px; border-radius: 0px; min-width: 80px; min-height: 31px; color: #fff; border: 2px solid #68943B; margin: 5px; box-shadow: 0px 0px 2px #c9c9c9; font-family: Segoe UI;}#form13 Please indicate the name of your service provider:* First Last How long (or how many sessions) have you been involved in this service for?:*The process of making the first appointment worked well:*AgreeNeither agree or disagreeDisagreeNot applicableThe waiting time for my first appointment was suitable:*AgreeNeither agree or disagreeDisagreeNot applicableI felt understood by my service provider:*AgreeNeither agree or disagreeDisagreeNot applicableI have benefited from the service:*AgreeNeither agree or disagreeDisagreeNot applicableI felt comfortable to use the service:*AgreeNeither agree or disagreeDisagreeNot applicableMy privacy and confidentiality was upheld in this service:*AgreeNeither agree or disagreeDisagreeNot applicableThe communication between my service provider and GP was useful:*AgreeNeither agree or disagreeDisagreeNot applicableI feel my service provider would welcome any feedback I have:*AgreeNeither agree or disagreeDisagreeNot applicableI would be willing to be referred again if the need arose:*AgreeNeither agree or disagreeDisagreeNot applicableI am aware of my rights to express concerns about any aspect of this service:*AgreeNeither agree or disagreeDisagreeNot applicableOverall, how would you rate your wellbeing improvement with the program?*Not at all SlightModerate SignificantMajorPlease tick the component(s) your health provider addressed well:*Listened to my storyHelped me understand my concerns betterHelped my family understand my concernsWorked with me to set goals and plan strategies to achieve themSupported me to make changes in my lifeConnected with me personallyAdvocated on my behalfLinked me with other helpful servicesHelped my GP support me betterHelped me understand new skillsHelped me explore and make sense of my feelings and thoughtsWhat does this service or your health provider do well?:What could be improved?Any other comments? Recaptcha Word Verification:SubmitReset JURI_ROOT =''; WDF_GRADING_TEXT ='Your score should be less than'; WDF_INVALID_GRADING = '`grading_label` Total should be less than `grading_total`'; FormCurrency ='$'; FormPaypalTax ='0'; function formOnload13() { if (wdformjQuery.browser.msie && parseInt(wdformjQuery.browser.version, 10) === 8) { wdformjQuery("#form13").find(wdformjQuery("input[type='radio']")).click(function() {wdformjQuery("input[type='radio']+label").removeClass('if-ie-div-label'); wdformjQuery("input[type='radio']:checked+label").addClass('if-ie-div-label')}); wdformjQuery("#form13").find(wdformjQuery("input[type='radio']:checked+label")).addClass('if-ie-div-label'); wdformjQuery("#form13").find(wdformjQuery("input[type='checkbox']")).click(function() {wdformjQuery("input[type='checkbox']+label").removeClass('if-ie-div-label'); wdformjQuery("input[type='checkbox']:checked+label").addClass('if-ie-div-label')}); wdformjQuery("#form13").find(wdformjQuery("input[type='checkbox']:checked+label")).addClass('if-ie-div-label'); } if(wdformjQuery.browser.msie) { wdformjQuery(".wdform-calendar-button").click(function() { var pos = wdformjQuery(this).offset().top; setTimeout(function(){ wdformjQuery(".calendar").each(function (){ if(wdformjQuery(this).css("display") == "block"){ wdformjQuery(this).css("top", parseInt(pos)-wdformjQuery(this).height()+"px"); } }); },300); }); } wdformjQuery("div[type='type_text'] input, div[type='type_number'] input, div[type='type_phone'] input, div[type='type_name'] input, div[type='type_submitter_mail'] input, div[type='type_paypal_price'] input, div[type='type_textarea'] textarea").focus(function() {delete_value(this)}).blur(function() {return_value(this)}); wdformjQuery("div[type='type_number'] input, div[type='type_phone'] input, div[type='type_spinner'] input, div[type='type_range'] input, .wdform-quantity").keypress(function(evt) {return check_isnum(evt)}); wdformjQuery("div[type='type_grading'] input").keypress(function() {return check_isnum_or_minus(event)}); wdformjQuery("div[type='type_paypal_checkbox'] input[type='checkbox'], div[type='type_paypal_radio'] input[type='radio'], div[type='type_paypal_shipping'] input[type='radio']").click(function() {set_total_value(13)}); wdformjQuery("div[type='type_paypal_select'] select, div[type='type_paypal_price'] input").change(function() {set_total_value(13)}); wdformjQuery(".wdform-quantity").change(function() {set_total_value(13)}); wdformjQuery("div[type='type_time'] input").blur(function() {add_0(this)}); wdformjQuery('.wdform-element-section').each(function() { if(!wdformjQuery(this).parent()[0].style.width && parseInt(wdformjQuery(this).width())!=0) { if(wdformjQuery(this).css('display')=="table-cell") { if(wdformjQuery(this).parent().attr('type')!="type_captcha") wdformjQuery(this).parent().css('width', parseInt(wdformjQuery(this).width()) + parseInt(wdformjQuery(this).parent().find(wdformjQuery(".wdform-label-section"))[0].style.width)+15); else wdformjQuery(this).parent().css('width', (parseInt(wdformjQuery(this).parent().find(wdformjQuery(".captcha_input"))[0].style.width)*2+50) + parseInt(wdformjQuery(this).parent().find(wdformjQuery(".wdform-label-section"))[0].style.width)+15); } } if(parseInt(wdformjQuery(this)[0].style.width.replace('px', '')) = 2*parseInt(wdformjQuery(this).css('line-height').replace('px', ''))) { wdformjQuery(this).parent().css('max-width',wdformjQuery(this).parent().width()); wdformjQuery(this).parent().css('width',''); } }); (function(wdformjQuery){ wdformjQuery.fn.shuffle = function() { var allElems = this.get(), getRandom = function(max) { return Math.floor(Math.random() * max); }, shuffled = wdformjQuery.map(allElems, function(){ var random = getRandom(allElems.length), randEl = wdformjQuery(allElems[random]).clone(true)[0]; allElems.splice(random, 1); return randEl; }); this.each(function(i){ wdformjQuery(this).replaceWith(wdformjQuery(shuffled[i])); }); return wdformjQuery(shuffled); }; })(wdformjQuery); wdformjQuery("").appendTo("#form13"); if(window.before_load) { before_load(); } } function formAddToOnload13() { if(formOldFunctionOnLoad13){ formOldFunctionOnLoad13(); } formOnload13(); } function formLoadBody13() { formOldFunctionOnLoad13 = window.onload; window.onload = formAddToOnload13; } var formOldFunctionOnLoad13 = null; formLoadBody13(); form_view_count13=0; for(i=1; i1) { for(i=1; i

Compliments, Complaints and Feedback Form