e-checkup feedback

Feedback on e-checkup

Thanks for participating in the e-checkup survey(s)! We would like your feedback on e-checkup so that we can determine whether to use it more widely and how to make it better.

* 1. Which of the e-checkup surveys did you take?

e-checkup for tobacco

e-checkup for alcohol

e-checkup for marijuana

e-checkup for sexual violence

all of the above

I didn't take the survey

* 2. Please rate the following statements as they relate to your experience with the alcohol survey. If you did not take the alcohol survey, skip to question 3.

	Strongly Disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree
I learned new information	I learned new information Strongly Disagree	I learned new information Disagree	I learned new information Neither agree nor disagree	I learned new information Agree	I learned new information Strongly agree
The survey helped me think about my own use	The survey helped me think about my own use Strongly Disagree	The survey helped me think about my own use Disagree	The survey helped me think about my own use Neither agree nor disagree	The survey helped me think about my own use Agree	The survey helped me think about my own use Strongly agree
The survey influenced my decisions around use	The survey influenced my decisions around use Strongly Disagree	The survey influenced my decisions around use Disagree	The survey influenced my decisions around use Neither agree nor disagree	The survey influenced my decisions around use Agree	The survey influenced my decisions around use Strongly agree
I would recommend this survey to my peers.	I would recommend this survey to my peers. Strongly Disagree	I would recommend this survey to my peers. Disagree	I would recommend this survey to my peers. Neither agree nor disagree	I would recommend this survey to my peers. Agree	I would recommend this survey to my peers. Strongly agree

* 3. Please rate the following statements as they relate to your experience with the tobacco survey. If you did not take the tobacco survey, skip to question 4.

	Strongly Disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree
I learned new information	I learned new information Strongly Disagree	I learned new information Disagree	I learned new information Neither agree nor disagree	I learned new information Agree	I learned new information Strongly agree
The survey helped me think about my own use	The survey helped me think about my own use Strongly Disagree	The survey helped me think about my own use Disagree	The survey helped me think about my own use Neither agree nor disagree	The survey helped me think about my own use Agree	The survey helped me think about my own use Strongly agree
The survey influenced my decisions around use	The survey influenced my decisions around use Strongly Disagree	The survey influenced my decisions around use Disagree	The survey influenced my decisions around use Neither agree nor disagree	The survey influenced my decisions around use Agree	The survey influenced my decisions around use Strongly agree
I would recommend this survey to my peers.	I would recommend this survey to my peers. Strongly Disagree	I would recommend this survey to my peers. Disagree	I would recommend this survey to my peers. Neither agree nor disagree	I would recommend this survey to my peers. Agree	I would recommend this survey to my peers. Strongly agree

* 4. Please rate the following statements as they relate to your experience with the marijuana survey. If you did not take the marijuana survey, skip to question 5.

	Strongly Disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree
I learned new information	I learned new information Strongly Disagree	I learned new information Disagree	I learned new information Neither agree nor disagree	I learned new information Agree	I learned new information Strongly agree
The survey helped me think about my own use	The survey helped me think about my own use Strongly Disagree	The survey helped me think about my own use Disagree	The survey helped me think about my own use Neither agree nor disagree	The survey helped me think about my own use Agree	The survey helped me think about my own use Strongly agree
The survey influenced my decisions around use	The survey influenced my decisions around use Strongly Disagree	The survey influenced my decisions around use Disagree	The survey influenced my decisions around use Neither agree nor disagree	The survey influenced my decisions around use Agree	The survey influenced my decisions around use Strongly agree
I would recommend this survey to my peers.	I would recommend this survey to my peers. Strongly Disagree	I would recommend this survey to my peers. Disagree	I would recommend this survey to my peers. Neither agree nor disagree	I would recommend this survey to my peers. Agree	I would recommend this survey to my peers. Strongly agree

* 5. Please rate the following statements as they relate to your experience with the sexual violence survey.

	Strongly Disagree	Disagree	Neither agree nor disagree	Agree	Strongly agree
I learned new information	I learned new information Strongly Disagree	I learned new information Disagree	I learned new information Neither agree nor disagree	I learned new information Agree	I learned new information Strongly agree
The survey helped me think about my own sexual behavior	The survey helped me think about my own sexual behavior Strongly Disagree	The survey helped me think about my own sexual behavior Disagree	The survey helped me think about my own sexual behavior Neither agree nor disagree	The survey helped me think about my own sexual behavior Agree	The survey helped me think about my own sexual behavior Strongly agree
The survey influenced my decisions around sexual behavior	The survey influenced my decisions around sexual behavior Strongly Disagree	The survey influenced my decisions around sexual behavior Disagree	The survey influenced my decisions around sexual behavior Neither agree nor disagree	The survey influenced my decisions around sexual behavior Agree	The survey influenced my decisions around sexual behavior Strongly agree
I would recommend this survey to my peers.	I would recommend this survey to my peers. Strongly Disagree	I would recommend this survey to my peers. Disagree	I would recommend this survey to my peers. Neither agree nor disagree	I would recommend this survey to my peers. Agree	I would recommend this survey to my peers. Strongly agree

* 6. We would appreciate your feedback. Is there anything you would like to add about your experience with the survey(s) you took?