Wellness Survey

Hangout Wellness Survey
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Name
Date of Birth
Please rate your level of satisfaction with the following aspects of this program:
Very SatisfiedSatisfiedNeutralUnsatisfiedVery Unsatisfied
Program Organization
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied
Facilitators
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied
Facility/Physical Environment
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied
Content of Program
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied
Length/Duration of the Program
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied
Program Meeting Your Needs/Expectations
Very Satisfied
Satisfied
Neutral
Unsatisfied
Very Unsatisfied
How did you feel before the program started today
How do you feel now?
How would you feel about participating in another program like this one?
How would you feel about recommending this program to others?
Please let us know your thoughts and comments about the hangout