Wufoo
WAITING LIST CONSULTATION
At Resources for Autism we are constantly trying to offer the best services to as many people as we can within our limited financial resources.
If you or a member of your family are on our waiting list this questionnaire will help us to try and meet your needs as quickly as we can. If you would be prepared to answer the questions below so we know what we need to do most urgently and can use your evidence to help us gain funding to do so.
If you are happy to give your name that would be great but if not please take just a few minutes to answer the questions below and then submit. You are welcome to add anything else that you would like us to know.
1: How old is the person waiting for a service with us?
2: Does the person on the waiting list already access any services with us?
YES
NO
2b: If yes, what is the service we provide?
3: Do they access any leisure services that is NOT school or day centre or other statutory provision (such as a residential unit)?
YES
NO
3b: If yes, what is the provision?
3c: How often is the above provision?
Daily
Weekly
Monthly
Occasionally
Less often
3d: Do they have to provide their own support (parent or carer) to access this provision?
Yes
No
4: Has the person on the waiting list been excluded from any other services or opportunities?
Yes
No
4b: If yes, why were they excluded?
5: What would be the most helpful service for the person on the waiting list to be able to access?
5b: What would prevent them from accessing this service (cost, distance, transport, support staff etc)?
6: Is there anything you really wish was provided locally for the person on the waiting list to access (not necessarily from us)?
7: What is the name of the person on the waiting list?
First
Last
YOU DO NOT HAVE TO DISCLOSE YOUR NAME IF YOU WISH.
8: If different from above, what is your name?
First
Last
YOU DO NOT HAVE TO DISCLOSE THE NAME IF YOU WISH.
9: Finally, is there anything else you think we would like to know?
Do Not Fill This Out