The Falling Monologues

25% of survey complete.

The Fall Prevention Coalition - Los Angeles, funded by The Kaiser Foundation, created The Falling Monologues to raise awareness about falls among older adults. We request your feedback in the questions below to help develop and improve additional fall prevention materials.

This survey should take about 5 minutes. Please note that most questions require responses in order to proceed through the survey.

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* 1. Please provide the following:

Contact Name:

Organization:

Location (City, State):

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* 2. Rate The Falling Monologues in the following categories:

	Poor	Adequate	Satisfactory	Good	Excellent
Encouraged viewers to talk openly about falls	Encouraged viewers to talk openly about falls Poor	Encouraged viewers to talk openly about falls Adequate	Encouraged viewers to talk openly about falls Satisfactory	Encouraged viewers to talk openly about falls Good	Encouraged viewers to talk openly about falls Excellent
Explained common fall risks	Explained common fall risks Poor	Explained common fall risks Adequate	Explained common fall risks Satisfactory	Explained common fall risks Good	Explained common fall risks Excellent
Provided ways to address common fall risks	Provided ways to address common fall risks Poor	Provided ways to address common fall risks Adequate	Provided ways to address common fall risks Satisfactory	Provided ways to address common fall risks Good	Provided ways to address common fall risks Excellent
Entertained the viewer	Entertained the viewer Poor	Entertained the viewer Adequate	Entertained the viewer Satisfactory	Entertained the viewer Good	Entertained the viewer Excellent

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* 3. Would you recommend The Falling Monologues:

	Yes	No	N/A
to a colleague?	to a colleague? Yes	to a colleague? No	to a colleague? N/A
to a friend/family member?	to a friend/family member? Yes	to a friend/family member? No	to a friend/family member? N/A

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* 1. Please provide the following:

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* 2. Rate The Falling Monologues in the following categories:

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* 3. Would you recommend The Falling Monologues:

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* 4. Tell us what you think of The Falling Monologues: