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Your Details: Age: Gender: Ethnicity: Community you live in: For each question below, please select a number from 1 to 7, where: 1=Poor 2=Fair 3=Okay 4=Good 5=Very Good 6=Great 7=Excellent ------------------------------------ 1. How was the service you received today? 1234567 ------------------------------------ 2. Do you feel respected, and cared for? 1234567 ------------------------------------ 3. Would you come back or recommend us to your friends or whānau? YesNoMaybe ------------------------------------ Any other comments or suggestions? Please leave your contact details if you wish to be contacted.