Whānau Feedback Form

Whānau Feedback Form

The following form is to help Poutini Waiora pinpoint area's of improvement. This insight will provide blueprints for how we can become a better service going forward. Please give your honest feedback.
Please select the Pou of the service used*

Hauora / HealthOranga / WellbeingHauora Hinengaro / Mental Health & AddictionsMātauranga / Education & Employment
This service includes:
- Winter Preparedness
- Immunisations
- Nurses (Registered, Practitioners, Tamariki, Ora etc.)
- Kaiawhina (Hauora)
This service includes:
- Kaiawhina (Mama & Pepi)
- Kaiawhina (Disability Support)
- Kaiawhina (Hauora)
- Whānau Ora Navigators
- Kai Puku
- Cancer Care
This service includes:
- Kaitakawaenga (Social Workers)
- Counsellers (Holistic, AOD, etc.)
- Restorative
- Whānau Resilience (Ko Wai Au)
- Kaiawhina (He Hikoi Manaaki)
- Kaiawhina (Rongoa)
This service includes:
- Kaiawhina (Mana Ake)
- Kaiawhina (ROCC)
- MOE
Name of Kaimahi that provided the service
Please rate how well you found each of the following:
- 1 = Very Poor
- 2 = Poor
- 3 = Average
- 4 = Good
- 5 = Great
How helpful did you find the service you received?*

1

2

3

4

5

1 is Very Poor, 5 is Great
How professional and respectful were our staff?*

1

2

3

4

5

1 is Very Poor, 5 is Great
How clear was the communication you recieved?*

1

2

3

4

5

1 is Very Poor, 5 is Great
How quick was our response? *

1

2

3

4

5

1 is Very Poor, 5 is Great
How satisfied are you with the results? *

1

2

3

4

5

1 is Very Poor, 5 is Great
Would you use Poutini Waiora's services again?*

YesNo
What did we do well?*
Do you have any suggestions for improvement?*
Any further comments?
Would you be open to being contacted regarding your submission? Any information you provide will be kept strictly confidential and used only for the purpose of improving our services and support*

YesNo
Whaiora Details

Providing your details is optional, but we truly value you and your insights. If you're comfortable, please share any information that might help us better understand your perspective and needs. Your details will be handled with care and confidentiality.
Name

First NameLast Name
Address (optional)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Waea pūkoro (Phone Number)

Area CodePhone Number
Imēra (Email)
example@example.com
Contact Information

If you would like any further information or have any questions, please feel free to reach out.
- Phone: 0800 333 170
- Email: enquiries@poutiniwaiora.co.nz
- Website: www.poutiniwaiora.co.nz
We’re here to listen and support you, and we appreciate your engagement in this process.
Thank you for taking the time to share your thoughts with us.

Your feedback is invaluable and plays a vital role in shaping the way we provide care and support. We deeply appreciate your insights.
Enquiries Email
example@example.com
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Whānau Feedback Form

Whaiora Details