Safe Space Community Feedback Form

This questionnaire is about your recent visit to Safe Space.

Please answer the following questions so we can understand your experience and recommendations on the service.

Thank you for taking the time to give feedback, it helps us improve our service.

Full Name *

First

Last

Date of Birth *

Which Safe Space did you visit? *

How would you rate your current level of crisis? (1 being very low crisis, 5 being very high crisis)

Selected Value: 1

1: Very low crisis. 2: Low crisis. 3: Neutral/No change. 4: High crisis. 5: Very high crisis.

How would you rate your current mood? (1 being great, 5 absolutely horrible)

Selected Value: 1

1: Great. 2: Good. 3: Fine. 4: Not good. 5: Absolutely horrible.

Have you been to A&E since attending Safe Space? *

I was treated with respect and dignity *

I felt heard and listened to *

Did we provide tools to help you work through and manage this crisis? *

If yes, what were they, and were they helpful?

Would you recommend the service?

What did we do well?

What can we improve on?

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