The Haven Women's Refuge

Feedback - Your Say!

We want to know what you think about The Haven and its services. We want you to have YOUR SAY so we can improve the services we offer. This form is for comments and complaints. A seperate complaints procedure is also available and can be obtained by calling 01902 572140.

Please take five minutes to complete the YOUR SAY Questionnaire. Your reply will be treated as confidential. You do not need to put your name on the form.

Please complete the form below. Alternatively you can fill in a Feedback Form and send it to The Haven Wolverhampton, PO Box 105, Wolverhampton, or e-mail performance@havenrefuge.org.uk.

1. Please tick which services you have used:
Referral Line:	Residential:	Welfare & Benefit Advice:
Floating Support:	Counselling:	Children's Services:
Advocacy:	Resettlement:
2. Were the services used:
Good	Satisfactory	Unsatisfactory
3. Please tick the type of support you received:
Accommodation:	Advocacy:	Benefits:
Furniture:	Clothing:	Children's Issues:
Information:	Health Issues:	Household goods:
Nursery Places:	Rehousing:	School Placements:
Support Groups:	Training:	Space to Talk:
Attending Appointments:	Childcare/Respite:	Group Work/Activities:
Referral to Agencies:	Support with a course:
Other (Please Specify):

4. Was the support received:
Good	Satisfactory	Unsatisfactory
Comments:

5. Were The Staff:
Approachable:		Yes	No
Professional:		Yes	No
Helpful:		Yes	No
Comments:

6. When You Visited / Stayed at The Haven:
Were you welcomed?		Yes	No
Was it clean and tidy?		Yes	No
Did you feel safe?		Yes	No
Did you feel listened to?		Yes	No
Comments:

7. Did you receive adequate information about The Haven, it's services and how to access them?
			Yes	No
Comments:

8. Are there any other areas of support you would like to see at The Haven?
			Yes	No
Comments:

9. Is there anything about The Haven and its services that you don't like?
			Yes	No
Comments:

Any further comments:

10. Would you like to talk to someone about your experience at The Haven or your ideas to improve our services?
			Yes	No
If YES, please provide your contact details:
Name:

Address:

Phone No:


Thank you for completing the 'Your Say' questionnaire