Feedback Sheet: [add name of your group clinic here]
By completing this form, I agree to my answers being used (in accordance with data protection law) for evaluation, development and improvement of health and care.
- Your Confidence Score- Complete at start and end of group
On a scale of 1-5 (where 5 is completely confident), how confident do you feel about knowing how to reduce your risk of heart attacks and strokes
| Starting Confidence score (1-5) | End confidence score (1-5) |
2) Your experience today
Please tick the box that best reflects how you feel about these statements after the group:
| Statement | Strongly disagree | Disagree | Not sure | Agree | Strongly agree |
| 1. This group helped me feel calmer and more connected with others | |||||
| 2. Because of this group, I am more likely to take steps to support my physical and/ or mental health | |||||
| 3. Because of this group, I know when I need a health professional and when I can manage on my own | |||||
| 4. The time I spent in the group was valuable | |||||
| 5. I trust the advice and information I received | |||||
| 6. I felt safe to share personal information in the group | |||||
| 7. This group could benefit people’s health or fitness for work |
| What worked well today? | What can we improve next time? |