KYM one-to-one session feedback form

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1. Out of 5, how was your wellbeing worker support overall?

	1	2	3	4	5
1 = not good, 5 = very good	11 = not good, 5 = very good 1	21 = not good, 5 = very good 2	31 = not good, 5 = very good 3	41 = not good, 5 = very good 4	51 = not good, 5 = very good 5

2. Out of 5, how did you find communicating with your wellbeing worker?

	1	2	3	4	5
1 = not good, 5 = very good	11 = not good, 5 = very good 1	21 = not good, 5 = very good 2	31 = not good, 5 = very good 3	41 = not good, 5 = very good 4	51 = not good, 5 = very good 5

3. Out of 5, how helpful was your wellbeing worker to achieve your GBO?

	1	2	3	4	5
1 = not good, 5 = very good	11 = not good, 5 = very good 1	21 = not good, 5 = very good 2	31 = not good, 5 = very good 3	41 = not good, 5 = very good 4	51 = not good, 5 = very good 5

4. Out of 5, how enjoyable and engaging did you find the sessions?

	1	2	3	4	5
1 = not good, 5 = very good	11 = not good, 5 = very good 1	21 = not good, 5 = very good 2	31 = not good, 5 = very good 3	41 = not good, 5 = very good 4	51 = not good, 5 = very good 5

5. Out of 5, how would you rate your overall experience with Know Your Mind?

	1	2	3	4	5
1 = poor, 5 = excellent	11 = poor, 5 = excellent 1	21 = poor, 5 = excellent 2	31 = poor, 5 = excellent 3	41 = poor, 5 = excellent 4	51 = poor, 5 = excellent 5

Please use the box below to tell us if there is anything you think your wellbeing worker could have done differently and/or any additional comments.

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