Private therapy feedback form

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Private therapy feedback form

Please help us continue to improve our services by answering some questions about the private therapy session(s) you have received from Cerebral Palsy Cymru. We are interested in your honest opinion, whether positive or negative. Please answer all of the questions. We also welcome your comments and suggestions.

Thank you very much, we appreciate your help and feedback.

Private therapy feedback form

Your details

Consent for storing submitted data *

Yes, I give permission to store and process my data

Todays date

First name *

Surname *

Email *

Contact number *

Who are you completing this form on behalf of?

My child
Myself
Someone else

Your child's information and your experience of our services

Child's first name

Child's surname

What service did you and your child receive from us?

Initial consultation
Single / one off therapy session
Block of therapy sessions
Other

How was the therapy session delivered?

Face to face / in person
video / online
Combination of video and face to face

We are constantly looking to improve our virtual therapy services. Please tick any of the statements below that apply to you

I like that I do not have to travel
I like that you can see our home set up
Doing therapy virtually gave me the opportunity to practice therapy activities directly with my child
I could follow the instructions / demonstrations during the video sessions
It was difficult to manage other siblings during the video sessions
My child behaved better at home than in a clinic when doing specific therapy activities
My child behaved better in a clinic than at home when doing specific therapy activities
I was able to set up the technology required
I found it difficult to manage the technology during the video sessions
I found the video call invasive to our privacy
I find video sessions easier than face to face sessions
I find face to face sessions easier than video sessions
I would recommend virtual therapy to other families / service users
I would not recommend virtual therapy to other families / service users

We are constantly looking to improve our virtual therapy services. Please tick any of the statements below that apply to you

How satisfied were you with the therapy session(s) you received?

Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied

On a scale of 1 to 10, with 1 being 'poor' and 10 being 'excellent', how would you rate the quality of the therapy you received?

Has the therapy session(s) contributed to your knowledge and understanding of your child's needs?

Yes
No
Unsure

Did you see a change in your child's abilities as a result of the therapy session(s)?

Much better
A little better
No change
Worse

Please give examples of the changes you have seen in your child

Has the therapy and the advice you have received helped you address any concerns you may have had prior to the session?

Yes, completely addressed my concerns
Yes, to a large extent
Yes, partially
No, not at all

Please tell us how the sessions may have helped you and / or your child? You may tick more than one box

Provided an opportunity to discuss concerns regarding my child
Provided emotional support
Improved my confidence in supporting my child
Improved my child's confidence
Provided practical advice and strategies I can use at home
Enabled me to be more active in carrying our activities directly with my child
Other

Testimonials are hugely valuable to us when promoting our services. If you are happy to do so, please could you provide a short testimonial or review of your experience accessing our services. Testimonials will be used to promote the service moving forward. If you would like to remain anonymous, please write 'anon' at the start or end of the testimonial.

Would you like to access more private therapy sessions in the future?

Yes
No
Unsure at this point

Are there any barriers that might prevent you from accessing our services in the future? If so, please note them below

Please feel free to add any further comments or suggestions as to how we can improve our private therapy service moving forward

Your experience of our services

What service did you receive from us?

Initial consultation
Single / one off therapy session
Block of therapy sessions
Other

How was the therapy session delivered?

Face to face / in person
video / online
Combination of video and face to face

We are constantly looking to improve our virtual therapy services. Please tick any of the statements below that apply to you

I like that I do not have to travel
I like that you can see our home set up
Doing therapy virtually gave me the opportunity to practice therapy activities at home
I could follow the instructions / demonstrations during the video sessions
I was able to set up the technology required
I found it difficult to manage the technology during the video sessions
I found the video call invasive to my privacy
I find video sessions easier than face to face sessions
I find face to face sessions easier than video sessions
I would recommend virtual therapy to other families / service users
I would not recommend virtual therapy to other families / service users

We are constantly looking to improve our virtual therapy services. Please tick any of the statements below that apply to you

How satisfied were you with the therapy session(s) you received?

Very satisfied
Satisfied
Neutral
Unsatisfied
Very unsatisfied

On a scale of 1 to 10, with 1 being 'poor' and 10 being 'excellent', how would you rate the quality of the therapy you received?

Did you see a change in your abilities as a result of the therapy session(s)?

Much better
A little better
No change
Worse

Please give examples of the changes you have seen thanks to the therapy session(s)

Has the therapy and the advice you have received helped you address any concerns you may have had prior to the session?

Yes, completely addressed my concerns
Yes, to a large extent
Yes, partially
No, not at all

Please tell us how the sessions may have helped you. You may tick more than one box

Provided an opportunity to discuss concerns
Provided emotional support
Improved my self confidence
Provided practical advice and strategies I can use at home
Enabled me to be more active in carrying our activities
Other

Would you like to access more private therapy sessions in the future?

Yes
No
Unsure at this point

Are there any barriers that might prevent you from accessing our services in the future? If so, please note them below

Please feel free to add any further comments or suggestions as to how we can improve our private therapy service moving forward

How did you find out about our private therapy service?

How did you find out about our private therapy service? *

Cerebral Palsy Cymru website
A leaflet
Word of mouth
Facebook advert
Social media post
Google search
Email from Cerebral Palsy Cymru
Provided information by Cerebral Palsy Cymru therapist
Other

Would you recommend our private therapy service to another person or family living with cerebral palsy?

Yes
No
Unsure

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Cerebral Palsy Cymru is a registered charity in England and Wales 1010183. A company limited by guarantee. Registered company in England and Wales 02691690. Registered address: Cerebral Palsy Cymru, 1 The Courtyard, 73 Ty Glas Avenue, Llanishen, Cardiff, CF14 5DX.