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Feedback Sharing Agreement

Please do not complete unless you have been asked to by one of our practitioners.  

As part of our organisation we are regularly required to feedback to others about the work that the MHSTs do. This can involve a number of different people including commissioners, other services, researchers, schools and sometimes other places we are asked to speak to about the work the team does. We often produce graphs to say things like how many referrals we received, how many sessions we offer and the interventions that we do. Whilst this is important, what people really want to know is what the people who use our service think of it. We also produce leaflets, videos, social media posts and other publications about our service and often people want to hear from the people who have used the service and what they thought.

At the end of your work with the team your practitioner may ask you if you would be willing to share your experience that we can then use for communications. This may be a summary of the work you did with your practitioner and the journey you went on. You and your practitioner will agree what this summary says. We will also ask you to complete a questionnaire to give us feedback about your experience with us, in your words.  

This form will tell us what you are happy for us to share and what you are not happy for us to share.

Any information you do agree to share will be anonymised. This means it will not include your name or your school and that you will not be able to be identified based on the information provided.

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Maximum 255 characters

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2.  

I/We are aware that for any agreement that I give that the information will be anonymised and I will not be able to be identified.

* required
3.  

I/We are aware that I can change my mind at any time by letting the MHST know and my feedback will no longer be used.  

* required
You can do this by emailing mhst@westsussex.gov.uk
4.  

I/We do not want any information shared

* required
5.  

I/We are happy for an agreed summary of my sessions and my feedback being shared for any communications

* required
If you consent to this you do not need to complete the rest of the questions if you do not wish to
6.  

I/We are happy for an agreed summary of my sessions to be shared in presentations to others 

(you and your practitioner will agree a summary of the work you did, and it will be presented verbally or in PowerPoint presentations)
7.  

I/We agree to my feedback being shared in presentations to others 

(if you have provided any comments on your questionnaires or direct to your practitioner these can be presented verbally or in PowerPoint presentations)
8.  

I/ We agree to my feedback being shared in written publications

(if you have provided comments to questionnaires or direct feedback this may be used in written publications such as leaflets)
9.  

I/We agree to my feedback being shared in online publications

(if you have provided comments to questionnaires or direct feedback this may be used in online publications such as Twitter, Facebook or Instagram posts)
10.  

I/We agree to the practitioner writing about the work we have done in academic work. I am aware that I will be anonymised and will not be identified. I am aware that I can request to see a copy of this work.

11.  

Young person in agreement 

* required
12.  

Parent/carer in agreement