Preparing for Your Surgery Video
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1.
1
. Did you watch the Preparing for Your Surgery Video?
Did you watch the Preparing for Your Surgery Video?
Yes (please respond to questions 2 through 8)
No (please explain why not and then skip to question 8)
If No, why not?
2
. How did you watch the Preparing for Your Surgery Video?
How did you watch the Preparing for Your Surgery Video?
DVD
Online
3
. Who watched the video? (Check all that apply)
Who watched the video? (Check all that apply)
Parents/Caregiver
Patient/Child
Other
Other (please specify)
4
. If a child watched the video, what was the age of the child?
If a child watched the video, what was the age of the child?
0-2 years old
3-5 years old
6-10 years old
11-15 years old
over 15 years old
N/A- child did not watch video
5
. How helpful was Preparing for Your Surgery in preparing YOU (parent/caregiver) for your child's upcoming surgery or procedure?
How helpful was Preparing for Your Surgery in preparing YOU (parent/caregiver) for your child's upcoming surgery or procedure?
Extremely helpful
Somewhat helpful
A little bit helpful
Not at all helpful
N/A- Parent/Caregiver did not watch video
6
. How helpful was Preparing for Your Surgery in preparing YOUR CHILD for the upcoming surgery or procedure?
How helpful was Preparing for Your Surgery in preparing YOUR CHILD for the upcoming surgery or procedure?
Extremely Helpful
Somewhat Helpful
A Little Bit Helpful
Not Helpful At All
N/A- Child did not watch video
7
. Would you recommend Preparing for Your Surgery to others?
Would you recommend Preparing for Your Surgery to others?
Yes
No
If No, why not?
8
. How would you prefer to receive information that helps you prepare for future appointments or procedures at Gillette? (Check all that apply)
How would you prefer to receive information that helps you prepare for future appointments or procedures at Gillette? (Check all that apply)
Watching a DVD at home
Watching a video online at home
Watching a video while at Gillette
Written material
No preference
Other
Other (please specify)
9
. What other topics would you like to see in video format?
What other topics would you like to see in video format?
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