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Child Safety Feedback and Complaints Form
Step
1
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5
20%
Full name (leave blank if anonymous)
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Why did you recently come to Legacy?
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How are you feeling?
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Happy/Cheerful
Excited/Amazed
Content/Pleased
Calm/Relaxed
Sad/Hurt
Shocked/Scared
Bored/Nothing
Confused/Unsure
Angry/Mad
Resentful/Frustrated
Tired/Stressed
Something else?
Write here
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Would you like to report a
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Worry
Problem
Feedback
Compliment
Complaint
Suggestion / Idea
Other
Other
(Required)
Who would you like to tell?
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Staff member
Manager
CEO (Big Boss)
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What do you want to tell us?
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What would you like to happen next?
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How would you like us to get back to you?
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Phone call
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What is your phone number?
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What is your email?
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