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1. Patient Resources/Tools Feedback Form

Please take a few minutes to complete this survey on the patient resources and/or tools you used. We welcome your feedback and appreciate your honesty on our materials, and would like to hear from you about what other patient materials you would like to see.

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* 1. Which patient resource or tool are you providing feedback on?

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* 2. Please rate the tool or resource you selected on the following:

  Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree N/A
It provided high-quality information.
It was easy to understand.
It answered my questions or providing the desired information.

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* 3. What questions did you have that were not answered by the resource or tool? What additional information would you have liked to see?

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* 4. Would you recommend this resource or tool to someone else?

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* 5. On what other topics would you like to see patient resources or tools?

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* 6. What format(s) do you prefer for patient resources or tools?

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* 7. Contact information (optional):

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