Connecting With Our Community

1. Tell us what you think of the session

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* 1. Rate the session

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
This session was a good use of my time.	This session was a good use of my time. Strongly Disagree	This session was a good use of my time. Disagree	This session was a good use of my time. Neutral	This session was a good use of my time. Agree	This session was a good use of my time. Strongly Agree
The comments or questions that I, or others, raised were addressed satisfactorily.	The comments or questions that I, or others, raised were addressed satisfactorily. Strongly Disagree	The comments or questions that I, or others, raised were addressed satisfactorily. Disagree	The comments or questions that I, or others, raised were addressed satisfactorily. Neutral	The comments or questions that I, or others, raised were addressed satisfactorily. Agree	The comments or questions that I, or others, raised were addressed satisfactorily. Strongly Agree
This session improved my understanding of sun damage/skin cancer.	This session improved my understanding of sun damage/skin cancer. Strongly Disagree	This session improved my understanding of sun damage/skin cancer. Disagree	This session improved my understanding of sun damage/skin cancer. Neutral	This session improved my understanding of sun damage/skin cancer. Agree	This session improved my understanding of sun damage/skin cancer. Strongly Agree
This session improved my understanding of the role of a plastic surgeon.	This session improved my understanding of the role of a plastic surgeon. Strongly Disagree	This session improved my understanding of the role of a plastic surgeon. Disagree	This session improved my understanding of the role of a plastic surgeon. Neutral	This session improved my understanding of the role of a plastic surgeon. Agree	This session improved my understanding of the role of a plastic surgeon. Strongly Agree
The audio-visual presentation improved my understating of the topics.	The audio-visual presentation improved my understating of the topics. Strongly Disagree	The audio-visual presentation improved my understating of the topics. Disagree	The audio-visual presentation improved my understating of the topics. Neutral	The audio-visual presentation improved my understating of the topics. Agree	The audio-visual presentation improved my understating of the topics. Strongly Agree
The room was a good location for the event.	The room was a good location for the event. Strongly Disagree	The room was a good location for the event. Disagree	The room was a good location for the event. Neutral	The room was a good location for the event. Agree	The room was a good location for the event. Strongly Agree
The time of the event was ideal.	The time of the event was ideal. Strongly Disagree	The time of the event was ideal. Disagree	The time of the event was ideal. Neutral	The time of the event was ideal. Agree	The time of the event was ideal. Strongly Agree
The amount of time allotted for the session was appropriate.	The amount of time allotted for the session was appropriate. Strongly Disagree	The amount of time allotted for the session was appropriate. Disagree	The amount of time allotted for the session was appropriate. Neutral	The amount of time allotted for the session was appropriate. Agree	The amount of time allotted for the session was appropriate. Strongly Agree

If you were neutral, disagreed, or strongly disageed with any of the statements above, please tell us why in the space below.

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* 2. Which previous session(s) have you attended?

Recognizing Signs and symptoms of a Heart Attack / Looking up: Plastic Surgery Improves Life for Victims of Violence (April 24, 2014)

Visiting Hours/ Battling the Stigma of Mental Health (February 25, 2014)

Going Wheat Free / Packing Your Suitcase for Surgery / Southlake Without Borders (November 12, 2013)

There's No Place Like Home: Getting you Home with the Support You Need (May 2, 2013)

Why the Wait: Pulling back the curtain on hospital wait times. (January 17, 2013)

This is the first lecture I have attended at Southlake

Other (please specify)

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* 3. How did you find out about this session?

Southlake Website

Southlake Signage

Email from Southlake

Email from a friend/associate

My Doctor's office

Community note in Newspaper/Online/Radio/Television

Was given a flyer at the Hospital

Word of mouth

Other (please specify)

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* 4. Do you plan to attend future Connecting With Our Community sessions?

Yes

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* 5. What topics would you be interested in seeing presented at future events?

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* 6. If you would like to be included on an e-mail notification list for future Connecting With Our Community sessions, please provide your name and e-mail address below:

Name:

E-mail Address: