Clatterbridge Cancer Centre Feedback Form

 

1. Date of Session

   DD/MM/YYYY 
 
 

2. Location e.g ward, waiting area

 

3. Did the session enable you to:

YesNo
Interact with others?
Express thoughts, feelings or ideas?
Experience improved mood?
Experience reduced anxiety?
 

4. Did you notice any changes in the environment as a result of the session? E.g. positive/ calm/ relaxed atmosphere

 

5. Do you have any feedback or suggestions for future sessions?