Thank you for attending the #BeMyVoiceLongBeach Events! Please take a moment to complete this feedback survey. We value your input. 

Question Title

* 1. What event did you attend?

Question Title

* 2. What role best describes you? (select one) 

Question Title

* 3. What is your age range? (select one)

Question Title

* 4. Rate your knowledge of advance care planning prior to attending the event.

Question Title

* 5. Rate your knowledge of palliative care prior to attending the event.

Question Title

* 6. Do you have an advance directive? 

Question Title

* 7. Have you identified someone who can speak for you if you were unable to speak for yourself?

Question Title

* 8. How likely are you to engage in advance care planning after this event?

Question Title

* 9. What type of action will you take? (select all that apply)

Question Title

* 10. Rate your knowledge of advance care planning after attending the event.

Question Title

* 11. Rate your knowledge of palliative care after attending the event.

Question Title

* 12. 12.   What would you like to see more of from future events surrounding advance care planning?

Thank you for taking the time to complete this survey. For additional information, please visit our website: talkaboutwhatmatters.org

T