Thank you for attending a Conversation Project event; we hope you found the information helpful. We also thank you for taking a moment to respond to a few questions. Your responses will be kept anonymous and help us learn more about the impact of our events and how to best support members of your community. If you have comments or questions for us, please respond to question 8.
About my own wishes:

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* 1. About my own wishes:

About my own wishes (please select all that apply)

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* 2. About my own wishes (please select all that apply)

  Yes, I had already done this. Yes, this was prompted by the Conversation Project event. No.
Get Ready: I have decided to have a conversation about my own wishes for care at the end of life.
Get Set: I have completed the Conversation Starter Kit.
Get Set: I have set up a time to talk with a loved one about my own wishes.
Go: I have shared my preferences for end-of-life care with someone close to me so he/she now knows more about what is important to me.
Keep Going: I have discussed my health care preferences with my doctor.
Keep Going: I have appointed a health care decision-maker (agent/proxy).
About a loved one's wishes:

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* 3. About a loved one's wishes:

About a loved one's wishes (please select all that apply)

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* 4. About a loved one's wishes (please select all that apply)

  Yes, I had already done this.  Yes, this was prompted by The Conversation Project event. No.
Get Ready: I have decided to have a conversation with a loved one about his/her wishes for care at the end of his/her life.
Get Set: I have shared the Conversation Starter Kit with a loved one.
Get Set: I have set up a time to talk about his or her wishes.
Go: A loved one shared his/her preferences for end-of-life care with me so I now know more about what is important to him/her.
Keep Going: My loved one has discussed his/her health care preferences with his/her doctor.
Keep Going: My loved one has appointed a health care decision-maker (agent/proxy).
My age is (optional):

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* 5. My age is (optional):

I identify as (optional):

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* 6. I identify as (optional):

My race/ethnicity is (optional, select all that apply):

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* 7. My race/ethnicity is (optional, select all that apply):

Any other questions or suggestions for us? For example, if you are not yet ready to have The Conversation, what's keeping you from taking the next step? Is there anything we could have done or included in our event to help you feel better prepared? (optional)

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* 8. Any other questions or suggestions for us? For example, if you are not yet ready to have The Conversation, what's keeping you from taking the next step? Is there anything we could have done or included in our event to help you feel better prepared? (optional)

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