Pre-Operative Joint Replacement On-Line Class

Your opinion is important to us. Please answer the following questions. Check the choice that best reflects your feelings about this on-line class.

The information you give will be kept confidential. It will only be used by the NMH Joint Replacement Program to help us know who takes the class. This will help us serve you better.
 
Thank you,
 
The NMH Joint Replacement Program.

Question Title

* 1. This class increased my knowledge of what to expect:

  Agree Somewhat Agree Disagree
a. Before Surgery
b. During My Hospital Stay
c.  During My Recovery At Home

Question Title

* 2. The content in the class was easy to understand.

Question Title

* 3. I would recommend this class to others having my type of surgery.

Question Title

* 4. Overall, I would rate the on-line class:

Question Title

* 5. My surgery will be done on my:

Question Title

* 6. My Surgeon is Doctor:

Question Title

* 7. My surgery is scheduled for: (please enter date below)

Question Title

* 8. My name is: (first initial and full last name, please)

T