Disclosure Tool Survey

Thank you for utilizing our Workplace Disclosure Interactive Assistant. We value your feedback and would appreciate your completion of the quick survey below.

1. Please identify yourself:

Please identify yourself: Person with MS

Relative of a person with MS

Friend of person with MS

Other (please specify)

2. Age:

Age:

3. What is your current employment status?

What is your current employment status? Working full time

Working part time

Working per diem or contract

Between jobs

Not working

4. Please rate the following:

	Excellent	Very Good	Good	Fair	Poor
Format	Please rate the following: Format Excellent	Format Very Good	Format Good	Format Fair	Format Poor
Content	Content Excellent	Content Very Good	Content Good	Content Fair	Content Poor
Resources	Resources Excellent	Resources Very Good	Resources Good	Resources Fair	Resources Poor
Ease of use	Ease of use Excellent	Ease of use Very Good	Ease of use Good	Ease of use Fair	Ease of use Poor

5. As a result of using the Interactive Assistant:

	Agree somewhat	Agree	Disagree somewhat	Disagree	Unsure N/A
I have a clearer picture of the things I need to consider before disclosing.	As a result of using the Interactive Assistant: I have a clearer picture of the things I need to consider before disclosing. Agree somewhat	I have a clearer picture of the things I need to consider before disclosing. Agree	I have a clearer picture of the things I need to consider before disclosing. Disagree somewhat	I have a clearer picture of the things I need to consider before disclosing. Disagree	I have a clearer picture of the things I need to consider before disclosing. Unsure N/A
It made me think about the advantages and disadvantages of disclosure.	It made me think about the advantages and disadvantages of disclosure. Agree somewhat	It made me think about the advantages and disadvantages of disclosure. Agree	It made me think about the advantages and disadvantages of disclosure. Disagree somewhat	It made me think about the advantages and disadvantages of disclosure. Disagree	It made me think about the advantages and disadvantages of disclosure. Unsure N/A
I have increased my knowledge of where to get information I need before making a decision.	I have increased my knowledge of where to get information I need before making a decision. Agree somewhat	I have increased my knowledge of where to get information I need before making a decision. Agree	I have increased my knowledge of where to get information I need before making a decision. Disagree somewhat	I have increased my knowledge of where to get information I need before making a decision. Disagree	I have increased my knowledge of where to get information I need before making a decision. Unsure N/A
I am more aware of where to go for assistance if I decide to disclose.	I am more aware of where to go for assistance if I decide to disclose. Agree somewhat	I am more aware of where to go for assistance if I decide to disclose. Agree	I am more aware of where to go for assistance if I decide to disclose. Disagree somewhat	I am more aware of where to go for assistance if I decide to disclose. Disagree	I am more aware of where to go for assistance if I decide to disclose. Unsure N/A

6. Are there any ways we can make the Interactive Assistant more useful?

Are there any ways we can make the Interactive Assistant more useful?

7. Additional Comments:

Additional Comments:

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