Thank you for participating in this educational program. To ensure our programs and services are of the highest quality, please take a moment to complete this brief survey. Your input is important to us and your responses will be used for quality improvement purposes only. Be assured they will be kept confidential and will never be sold.
PRIMARY EMAIL ADDRESS:
FIRST NAME
LAST NAME
PRIMARY PHONE
PROGRAM NAME
PROGRAM DATE
MM
/
DD
/
YYYY
CampaignMemberId
Campaign ID
Account ID - Email Look Up
Account ID - First Last Phone Look Up
PersonAccount ContactId
EXPERIENCE WITH THIS PROGRAM
Extremely Satisfied
Satisfied
Neither Satisfied Nor Dissatisfied
Dissatisfied
Extremely Dissatisfied
Overall satisfaction
Value of program content related to your wellbeing
Presenter’s knowledge of the subject
The description of the program matched the program content
Yes
No
HOW LIKELY ARE YOU TO:
Extremely Likely
Likely
Neither Likely Nor Unlikely
Unlikely
Extremely Unlikely
Recommend future programs
Use the information learned from the program
Overall, what did you like best about the program?
How could the program have been better?
Other comments – please share any additional information about your program experience
How did you learn about this program?
CHWB Print Calendar
CHWB Email
CHWB Website
Eventbrite
CHWB Social Media (Facebook, Instagram)
Word of Mouth (friend, coworker, etc.)
CHWB Staff
Elsewhere (Specify Below)
(Please specify):
Survey follow-up
Based on your responses, would you allow us to contact you to obtain additional information?
Yes
No
SUBMIT FORM
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