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Bangor Symphony Orchestra Music and Wellness Program Post Visit Survey
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Performance date
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Where did this experience take place?
Your answer
Please rate any changes regarding how you/the patient felt before the music as compared to after the music program.
Energy level before the music
Less energy
1
2
3
4
5
More energy
Clear selection
Energy level after the music
Less energy
1
2
3
4
5
More energy
Clear selection
Feelings of relaxation before the music
Less relaxed
1
2
3
4
5
More relaxed
Clear selection
Feelings of relaxation after the music
Less relaxed
1
2
3
4
5
More relaxed
Clear selection
Mood response to the music
Negatively impacted
1
2
3
4
5
Positively impacted
Clear selection
Physical response to the music
Negatively impacted
1
2
3
4
5
Positively impacted
Clear selection
Overall, did you find this program beneficial? Please elaborate.
Your answer
What changes or improvements would you suggest?
Your answer
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