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Patient Feedback Survey of Educational Videos
1.
Please tell us what you think about the video(s) you watched by indicating how much you agree or disagree with each of the statements below. Select the response which best indicates how you feel about each statement. There are no right or wrong answers.
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
I enjoyed the educational video?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
The video was just the right length to watch?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
The video helped me understand how to manage my daily activities given my condition?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
I found the video content to be practical and useful?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
The video was easy to follow and understand?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
The video has prompted me to consider changing my health care behavior?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
The video made learning about health a better experience than I would have had otherwise?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
Staff explained what medication they should take and how and when to take it?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
During discharge planning, I received information I could understand about what symptoms or problems I may experience?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
The Parker staff took my preferences and those of my family into account in deciding what my health care needs would be when I left Parker?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
After watching the video, I feel more confident in caring for my condition?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
After watching the video, I clearly understood the purpose of taking each of my medications?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
After watching the video, I had a good understanding of the things I was responsible for in managing my health?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
After watching the video, I feel more confident about symptoms and health problems to look for when I leave Parker?
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
2.
What video did you view?
Making the Transition to Parker
Managing Your Medications
Managing Hypertension
Diabetes Care
Meal Preparation
Heart Failure
Medical Equipment
Fall Prevention
Skin Care
Recovery After Hip and Knee Surgery
The Importance of Home Care
Making the Transition to Home
3.
Age
Under 64
65-74
75-84
85+
4.
Sex
Male
Female
Other
Prefer not to Answer
5.
What is your race or ethnicity?
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Multiracial or Multiethnic
Native American or Alaska Native
Native Hawaiian or other Pacific Islander
White
Another race or ethnicity, please describe below
Self-describe below:
6.
What is your relationship to the resident/patient?
I am a resident/patient
I am a caregiver
7.
Patient Information (optional)
First Name
Last Name
8.
Comments
Current Progress,
0 of 8 answered