WEIOP Feedback

WEIOP Feedback Form

The purpose of this feedback section is to ensure that the WEIOP is delivering meaningful programming. Please feel free to share your thoughts on our clinical services.

1. Could you share what stage or treatment you are currently in?

In Treatment

Completed Treatment

Withdrawn from Treatment

Prefer not to answer

2. To what extent do you think the information you learned in the program will be helpful in your everyday life?

Extremely Unhelpful

Somewhat Unhelpful

Neutral

Somewhat Helpful

Extremely Helpful

2.1 Please tell us why:

3. To what extent did you find group discussions helpful for your learning experience?

Extremely Unhelpful

Somewhat Unhelpful

Neutral

Somewhat Helpful

Extremely Helpful

3.1 Please tell us why:

4.1 Please tell us why:

5.1 Please tell us why:

6. Please tell us about your experience with your treatment providers and/or IOP staff. We would love to know about your positive experiences and places where you feel we could grow. Please select the provider(s) you would like to tell us about.

Social Worker

Dietitian

Nurse Practioner

Psychiatrist

Other

6.1 Please indicate staff name(s) with comments

7. What group topics were the most interesting to you?

8. Were there any group topics that you felt were not as relevant or useful? Or are there topics you would like to suggest?

9. How did you feel in our physical space? Is there anything you would suggest we consider changing?

10. Any additional comments:

11. Your feedback is incredibly valuable. We sometimes use anonymous or attributed quotes from clients/service recipients in reports or media campaigns. Do you consent to have your written feedback and/or comments from this form being used ?

Yes

12. If you answered "Yes" to the question above, please indicate how you would allow your feedback to be used:

I consent to my feedback being used and attributed with my name (e.g., "Jane D. Smith, Attendee")

I consent to my feedback being used anonymously (e.g., "A presentation attendee")

12.1 If you would like to be attributed, please provide your Name (Optional):