PULSE Evaluation

As we try to measure our success at PULSE, or improve on our services, please take a moment to complete the following survey. Please answer the following questions to the best of your ability.

Question Title

* 1. Have you ever:

Been to a PULSE meeting?

Been to a PULSE workshop or focus group?

Heard a PULSE speaker?

Reviewed materials on the PULSE website?

Reviewed PULSE literature at a fair or other event?

Worked one on one with a PULSE representative?

Heard of PULSE, a patient advocacy organization?

Other (please specify)

Question Title

* 2. Are you completing this survey as

the patient

a friend

a family member of the patient

a medical professional

Other (please specify)

Question Title

* 3. If you are the patient, have you been to a doctor's office, clinic or been hospitalized since learning about PULSE and our services?

Yes

Question Title

* 4. Did you do anything different that may have improved the outcome of your care because of PULSE and the knowledge you received?

Yes

If yes, please give a detailed description how information from PULSE may have contributed to a better outcome. Please be as specific as possible:

Question Title

* 5. If you were the friend or family member of the patient, did you do anything different that may have improved the outcome for the patient because of knowledge you received from PULSE?

Yes

If yes, please give a detailed description how information from PULSE may have contributed to a better outcome. Please be as specific as possible:

Question Title

* 6. If you are a medical professional, do you do anything different that may improve the outcome for the patient because of knowledge you received from PULSE?

Yes

f yes, please give a detailed description how information from PULSE may have contributed to a better outcome for a patient. Please be as specific as possible:

Question Title

* 7. To validate this survey, please tell us your name and how we might contact you for additional questions.

Name

City,

State, Zip Code

E-Mail

Phone #