Music Making Feedback Form

We hope you have enjoyed today’s session. Please could you spend a few minutes giving us some feedback? Ideally now while it is fresh in your mind!

If you are on your own, just complete it for “Participant 1”. If you attended with a companion please complete “Participant 2” as well.

Name – Person 1 *

Name – Person 2 (Companion)

How would you rate today's session overall (5=Best)

Selected Value: 1

Participant 2:

Selected Value: 1

What did you most enjoy about the session?

Participant 2:

Do you feel you were adequately supported? (5=Best)

Selected Value: 1

Participant 2:

Selected Value: 1

What additional support would you have liked, if any? *

How do you think your mood may have changed during today's session?

Selected Value: 1

1= Much worse, 2 = A bit worse, 3= No change, 2= A bit better, 5= Much better

Participant 2:

Selected Value: 1

1= Much worse, 2 = A bit worse, 3= No change, 2= A bit better, 5= Much better

What are your thoughts about the programme so far? *

Is there anything that would improve the sessions?

Finally, do you have any other comments?

Would you like to recieve our quarterly Newsletter?

Tick if ‘Yes’

Contact us

Address

Correspondence address:
Arts 4 Dementia, 70a Edgewood Drive, Green Street Green, Kent BR6 6LH

Registered address:
Arts 4 Dementia, Zeeta House, 200 Upper Richmond Road, London SW15 2SH

Registered Company No: 07511427
Registered Charity No: 1140842

Telephone

020 3633 9954

E-Mail

info@arts4dementia.org.uk

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Our Supporters

Our Patrons

HSH Dr Donatus Prince von Hohenzollern, Harry Cayton CBE, Katie Derham, Sir Richard Eyre CBE, FRSL, Colin Ford CBE, Dame Emma Kirkby DBE, Professor Sir Andrew Motion FRSL, FRSA, Baroness Neuberger DBE, Dr Charles Robert Saumarez Smith CBE, Andrew Wilton FSA, Gillian Wolfe CBE, FRSA, Chair of the Conference Committee