Telehealth and LGBTQIA+ Communities Toolkit Feedback Form

Thank you for attending this training. Please take a moment to fill out this brief evaluation as it helps us to improve our programming.

Question Title

* 1. How would you rate your level of knowledge about this content BEFORE using the toolkit?

Very Low

Low

Neutral

High

Very High

Very Low

Low

Neutral

High

Very High

Question Title

* 2. How would you rate your level of knowledge about this content AFTER using the toolkit?

Very Low

Low

Neutral

High

Very High

Very Low

Low

Neutral

High

Very High

Question Title

* 3. Based on your level of knowledge prior to today's session, how would you rate your changes to your knowledge after using this toolkit?

Extremely high level of knowledge gained

High level of knowledge gained

Moderate level of knowledge gained

Minimum level of knowledge gained

No knowledge gained

Question Title

* 4. How confident are you that you will be able to apply the information from this toolkit to your work/your organization?

Extremely confident

Very confident

Moderately confident

Somewhat confident

Not at all confident

Question Title

* 5. I hope to use what I've learned from this toolkit to (check all that apply):

Champion policy/procedure changes in my organization.

Disseminate information to colleagues and/or other staff in my organization.

Inform the implementation of staff training.

Improve community outreach efforts/Build connections to community.

Improve my clinical knowledge in order to provide better patient care.

Other (please specify)

Question Title

* 6. Overall, how satisfied are you with this toolkit?

Extremely satisfied

Very satisfied

Moderately satisfied

Somewhat satisfied

Not at all satisfied

Extremely satisfied

Very satisfied

Moderately satisfied

Somewhat satisfied

Not at all satisfied

Question Title

* 7. How likely are you to recommend the toolkit to a colleague?

Very likely

Likely

Neither likely nor unlikely

Unlikely

Very unlikely

Very likely

Likely

Neither likely nor unlikely

Unlikely

Very unlikely

Telehealth and LGBTQIA+ Communities Toolkit Feedback Form

Question Title

* 1. How would you rate your level of knowledge about this content BEFORE using the toolkit?

Question Title

* 2. How would you rate your level of knowledge about this content AFTER using the toolkit?

Question Title

* 3. Based on your level of knowledge prior to today's session, how would you rate your changes to your knowledge after using this toolkit?

Question Title

* 4. How confident are you that you will be able to apply the information from this toolkit to your work/your organization?

Question Title

* 5. I hope to use what I've learned from this toolkit to (check all that apply):

Question Title

* 6. Overall, how satisfied are you with this toolkit?

Question Title

* 7. How likely are you to recommend the toolkit to a colleague?

Question Title

* 8. What other additional resources do you need to meet your education needs?

Question Title

* 9. What other feedback would you like to share with us?