Activity Feedback - Dragonfly Cancer Trust

Please complete this form and return via email to info@dragonflycancertrust.org to confirm that you wish to receive further consignments of Activity Boxes from Dragonfly Cancer Trust. The information you provide will be used to demonstrate the impact of our service and help us to improve the quality, contents and delivery of our Activity Boxes. In order for us to do this we rely on your feedback and if you are willing to share photographs of completed activities with Dragonfly Cancer Trust and outline the impact these activities have on the young patients you support, please feel free to add comments and photographs to this email.

Hospital Name

Ward Number/Name

Number of patients who benefit from using this box

Contact 1 First Name

Contact 1 Surname

Job Title

Phone Number

Contact 1 Email

Contact 2 First Name

Contact 2 Surname

Job Title

Phone Number

Contact 2 Email

How would you rate the contents of this Activity Box?

We would be grateful if you highlight any items in this activity box that you particularly liked

Are there any items you did not use or do you have any suggestions for future boxes

What impact did this activity box have for you patients (please tick)

Other

The information you provide will be used to demonstrate the impact of our service and help us to improve the quality, contents and delivery of our Activity Boxes. In order for us to do this we rely on your feedback

Thank you for taking the time to complete this form.