Bounce Back Feedback Form & Questionnaire

 
Please answer the following questions &/or make comments about the program as a whole, the Workbooks, the DVD, your Coach, or any other particular parts of the Bounce Back program.
1. What is your...
2. Who was your Bounce Back Coach: (Optional)
Provide one response for each on the 1 to 5 scale indicated.
3. How would you rate...
1 = very poor2 = poor3 = fair/so-so4 = good5 = very goodN/A = doesn't apply
the overall quality of the Bounce Back (BB) program / service?
the accessibility of, or ease of access to, the Bounce Back program?
the reliability or dependability of the Bounce Back program / service?
your satisfaction with the DVD you were given as part of this program?
your satisfaction with the workbooks & other materials you used?
your satisfaction with the coaching you received by telephone?
the BB program’s ability to help you make positive life-changes?
your confidence that you will be able to maintain these changes?
the chance that you will recommend BB to a friend or family member?
4. Comments:
5. If you would like a response regarding your feedback, please provide your name and contact information (Optional)
Any information you provide will be used to help us improve the quality of our program for participants in the future. Also, periodic summaries of feedback from all participants (which will not contain personally-identifying information) may be provided to the BC Ministry of Health.
Thank you very much for your feedback!
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