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Integrated Wellness Survey

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Name

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Last

Email Address

Date of Birth

Self-Identified Gender

Hangout Attended

Session Date

Please rate your level of satisfaction with the following aspects of this program:

	Very Satisfied	Satisfied	Neutral	Unsatisfied	Very Unsatisfied
Program Organization	Very SatisfiedProgram Organization Very Satisfied	SatisfiedProgram Organization Satisfied	NeutralProgram Organization Neutral	UnsatisfiedProgram Organization Unsatisfied	Very UnsatisfiedProgram Organization Very Unsatisfied
Facilitators	Very SatisfiedFacilitators Very Satisfied	SatisfiedFacilitators Satisfied	NeutralFacilitators Neutral	UnsatisfiedFacilitators Unsatisfied	Very UnsatisfiedFacilitators Very Unsatisfied
Facility/Physical Environment	Very SatisfiedFacility/Physical Environment Very Satisfied	SatisfiedFacility/Physical Environment Satisfied	NeutralFacility/Physical Environment Neutral	UnsatisfiedFacility/Physical Environment Unsatisfied	Very UnsatisfiedFacility/Physical Environment Very Unsatisfied
Content of Program	Very SatisfiedContent of Program Very Satisfied	SatisfiedContent of Program Satisfied	NeutralContent of Program Neutral	UnsatisfiedContent of Program Unsatisfied	Very UnsatisfiedContent of Program Very Unsatisfied
Length/Duration of the Program	Very SatisfiedLength/Duration of the Program Very Satisfied	SatisfiedLength/Duration of the Program Satisfied	NeutralLength/Duration of the Program Neutral	UnsatisfiedLength/Duration of the Program Unsatisfied	Very UnsatisfiedLength/Duration of the Program Very Unsatisfied
Program Meeting Your Needs/Expectations	Very SatisfiedProgram Meeting Your Needs/Expectations Very Satisfied	SatisfiedProgram Meeting Your Needs/Expectations Satisfied	NeutralProgram Meeting Your Needs/Expectations Neutral	UnsatisfiedProgram Meeting Your Needs/Expectations Unsatisfied	Very UnsatisfiedProgram Meeting Your Needs/Expectations Very Unsatisfied

Comments

Please let us know your thoughts and comments about the hangout

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