2015 Five Diamond Planning Webinar Feedback Question Title * 1. Your Role Patient Care Partner Family Member Physician Nurse Technician Social Worker Dietician Administrator Other Other (please specify) Question Title * 2. 5 Diamond Program Participation: My Facility: Already participates in the 5 Diamind Program Plans to Participate in the 5 Diamnd Program Will NOT participate in the Five Diamond Program We are still deciding if the program is right for us N/A Other (please specify) Question Title * 3. The Webinar was easy to understand Strongly Disagree Disagree Neutral Agree Strongly Agree N/A Strongly Disagree Disagree Neutral Agree Strongly Agree N/A Question Title * 4. The subject matter was important to me Strongly Disagree Disagree Neutral Agree Strongly Agree N/A Strongly Disagree Disagree Neutral Agree Strongly Agree N/A Question Title * 5. I will share this information Strongly Disagree Disagree Neutral Agree Strongly Agree N/A Strongly Disagree Disagree Neutral Agree Strongly Agree N/A Other (please specify) Question Title * 6. The content of the webinar was compelling Strongly Disagree Disagree Neutral Agree Strongly Agree N/A Strongly Disagree Disagree Neutral Agree Strongly Agree N/A Other (please specify) Question Title * 7. The webinar had new, useful information for me Strongly Disagree Disagree Neutral Approve Strongly Approve N/A Strongly Disagree Disagree Neutral Approve Strongly Approve N/A Other (please specify) Question Title * 8. Please list any ideas for future topics for patient/provider education and/or any comments about this webinar Question Title * 9. I would like to be a member of the Network's 2015 Learning and Action Networks (of Yes, please provide your name and contact informatin in the comment box, and we will reach out to you) Yes No Other (please specify) Done