JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Walk with a Doc Post-Event Survey
Thank you for hosting a Walk with a Doc event! Please have your chapter leader complete the survey below after each walk and let us know if there's anything we can do to help support you for the next event!
Sign in to Google
to save your progress.
Learn more
* Required
Chapter Number
*
Your answer
Your Name
Your answer
Email Address
Your answer
Walk Date
*
MM
/
DD
/
YYYY
Number of Participants
*
Your answer
Speaker/leader for this event
Please include the first and last name(s) of the physicians/students who gave the health talk at this particular event.
Your answer
Health Topic
Your answer
Was this walk in a rural and/or underserved community?
*
Rural
Underserved
Rural & Underserved
None of the above
Please provide any additional feedback: good or bad!
Your answer
Thanks for completing this survey! After hitting "submit" below, please email
contact@walkwithadoc.org
or call 614-714-0407 with any questions, website updates, or anything we can do to help support you. We're excited for your next walk!
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Walk with a Doc.
Report Abuse
Forms
