Planning for your Future Feedback Form

Date of Presentation:

1. What part of the presentation from Age UK Surrey did you find most helpful?

2. Did you learn anything new about planning for the future that you did not know before? If yes, please give examples.

3. Do you feel more informed about planning for future care? Yes No Maybe

4. After hearing the presentation how likely or unlikely are you to start planning for your future care or future care of a loved one? Very likely Likely Neither likely or unlikely I am already making plans Unlikely Very unlikely I don’t know

5. To what extent do you agree or disagree that the presentation has made you more confident to start a conversation about the future with someone you trust? Strongly agree Agree Neither agree or disagree Disagree Strongly disagree

6. Overall, how helpful was the presentation? Very helpful Helpful Neither helpful or unhelpful Slightly helpful Not at all helpful

7. Did you attend today for yourself or on behalf of a loved one? Myself On behalf of someone else Both myself and someone else

8. Would you recommend the presentation to a friend or a family member? Yes No Maybe Don't know

9. Are you planning to follow up with any of the organisations mentioned? Yes No Maybe

If yes, which ones?

10. Please tell us how your experience of the presentation could be improved.

11. What is your ethnic group? (We collect data on demographics to highlight any inequalities and ensure inclusivity of services and engagement activities) White - British, English, Northern Irish, Scottish or Welsh White - Irish White - Gypsy or Irish Traveller Any other White background White and Black Caribbean White and Black African White and Asian Any other mixed or multiple ethnic background Asian or Asian British - Indian Asian or Asian British - Pakistani Asian or Asian British - Bangladeshi Asian or Asian British - Chinese Any other Asian background Black or Black British - Caribbean Black or Black British - African Any other black British, Caribbean or African background Arab Other ethnic group (please specify below) Prefer not to say

If other ethnic group, please specify:

12. How old are you? 18-24 25-34 35-44 45-54 55-64 65-74 75 and over Prefer not to say

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'Planning for your future' Feedback Form