Health and Wellbeing Programme Feedback Form We'd love to hear your feedback on us. Thank you for taking the time to let us know what you think of the services we provide. Please fill in the questions below with as much information as possible as this will help us continue to improve the service we provide.
1
. First Name
2
. Last Name
3
. Which part/s of your customer experience are you commenting on?
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Customer Service
Cleanliness
Pricing
Venue
Instructors/Coaching
Programme Delivery
Other (please specify)
4
. Which activity area/s are you commenting on?
*
Stop Smoking
NHS Health Checks
Adult Weight Management
Child & Family Weight Management
Healthy Pregnancy
Long Term Conditions
Exercise Referral
Social Prescription
Young Persons Social Prescription
Maternal and Early Years Social Prescription
MECC Training
High Intensity Use
Other (please specify)
5
. Would you say that you were making a .....?
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Complaint
Compliment
Comment / Suggestion
6
. What would you like to tell us?
*
7
. Date & Time of visit
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8. Would you like a response?
Yes
No
Membership Number (Optional)
Preferred Contact Method
Phone
Email
Email Address
*
Phone Number
*
Submit