028 3756 3946
verve.network@southerntrust.hscni.net

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Wellbeing Programmes
Verve Network Organisations
News
Contact Us
Referral Form
Referral Agents
- HCP Referral Form
- Resource for Referral Agents

Wellbeing Programmes
Verve Network Organisations
News
Contact Us
Referral Form
Referral Agents
- HCP Referral Form
- Resource for Referral Agents

Final Visit Client Questionnaire

To be completed by clients on/or after final session with the health trainer

1. Why did you take part in the Community Health Trainer Programme? *

2. What concerns did you wish to address? *

3. Did you achieve your goals? *

Yes
No
Partly
Not at all

4. To help us assess our service please answer the following questions.

Completed a health behaviour check *

Yes
No
Don't Know

Set behaviour change goals *

Yes
No
Don't Know

Created a personal health action plan *

Yes
No
Don't Know

Used a behaviour change diary *

Yes
No
Don't Know

Completed a progress review *

Yes
No
Don't Know

5. How has the health trainer programme benefited you? (please click the relevant answers)

Given me the confidence to be my own health trainer
Shown me how to set realistic goals
Helped me to achieve my personal health goals
Given me confidence in myself
Helped me feel better
I have made new friends
Made more time for myself
Feel better connected within my community
Improved my sense of health and wellbeing
Other

Other (Please state)

6. How confident are you in your ability to maintain the changes you have made? *

Not at all confident
Slightly confident
Confident
Fairly confident
Very confident

7. How do you feel about what you have achieved? *

Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied

8. Were you satisfied with the following?

Pre appointment communication *

Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied

The venue *

Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied

The timings of your meetings *

Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied

The information given *

Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied

feel the your

The materials used in your meetings *

Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied

Your Health Trainer *

Very dissatisfied
Dissatisfied
Neutral
Satisfied
Very satisfied

9. Do you have any further comments on the Health Trainer service? *

10. Full Name *

11. Date of Birth *

12. Contact phone number. *

13. Postcode *

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