Thank you for participating in the National Preparedness Month Activities. Please complete the following survey to give us feedback and let us know your facility participated.

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* 1. Please enter your facility name.

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* 2. Please enter your first and last name.

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* 3. How did you receive the weekly activities?

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* 4. Do you have a Facility Patient Representative (FPR)?

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* 5. Did you share the activities with your patients, FPR, or both?

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* 6. The activities were informative for facility staff and patients.

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* 7. The most helpful/useful activity for my facility was the (you may choose more than one)...

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* 8. What did you like about the National Preparedness Month weekly activities?

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* 9. Let us know how we can improve the National Preparedness Month weekly activities next year.

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