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Living Room Evaluation Form
Evergreen values your feedback as participants of the C-Care Cancer Support Group. The answers you provide will be used to maintain quality, improve service and support your overall satisfaction. This is an anonymous questionnaire. Please do not put your name on it. Thank you in advance.
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Group Facilitator(s):
*
Your answer
Date of last session attended:
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Please check the number that best matches how you feel:
(1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, 5 = strongly agree)
The facilitator(s) is friendly, helpful, respectful, caring and positive.
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5
Clear selection
The facilitator(s) is prepared, and delivers the program topics well.
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5
Clear selection
The facilitator(s) encourages participation and group cohesion.
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5
Clear selection
The volunteers are friendly, helpful, caring and positive.
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5
Clear selection
The facility (meeting, dining and kitchen areas) are clean, safe and comfortable.
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5
Clear selection
The social lunch is enjoyable and Evergreen accommodates taste, dietary and cultural diversity.
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5
Clear selection
The activities are fun, interesting and varied.
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5
Clear selection
I like the format (Quote, Did you know, Activity, Social Lunch) and learned things that could help me in the future.
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5
Clear selection
I have developed a connection with the people in the group.
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5
Clear selection
The Living Room helps me feel like I have a better quality of life than without it.
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5
Clear selection
My positive experience may lead me to call Evergreen in the future for support.
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5
Clear selection
As a result of participating in the program, I might call Evergreen for resources rather than call/see my doctor less for non-medical support.
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5
Clear selection
I have learned about community resources which I use or would use if needed.
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5
Clear selection
I would recommend this program to others
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5
Clear selection
I value the art, music and sing-a-long programs
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5
Clear selection
I value the health information and speakers.
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5
Clear selection
I value the massage therapist/other practitioners.
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5
Clear selection
I value the information on chronic conditions, quality of life improvements, healthy eating and stress reduction strategies.
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5
Clear selection
If I had an idea for a topic or presenter, I feel comfortable suggesting it.
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5
Clear selection
What do you like most about the group? (massage, yoga, bingo, speakers and demonstrations)
Your answer
What would you like to learn more about?
Your answer
Additional comments and suggestions?
Your answer
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