Supporting Healthy Alternatives through Patient Education

Participant Evaluation

SHAPE Session Evaluation

Today’s Date ___ ___ / ___ ___ / ___ ___ Session #: 1 2 3 4 5

1) Please rate the following aspects of the session by circling the appropriate rating:

a) Overall session Excellent Good Fair Poor

b) Usefulness of the videos for discussion Excellent Good Fair Poor

c) Usefulness of the materials given to you Excellent Good Fair Poor

d) Usefulness of the exercises Excellent Good Fair Poor

e) Session leader’s overall performance Excellent Good Fair Poor

2)Please circle the rating that best describes how you feel about the following aspects of the session:

I learned something in this session Strongly Agree Agree Disagree Strongly Disagree

The session dealt with things that are real for me Strongly Agree Agree Disagree Strongly Disagree

The videos were good for discussion Strongly Agree Agree Disagree Strongly Disagree

The materials were helpful for me Strongly Agree Agree Disagree Strongly Disagree

The exercises were helpful for me Strongly Agree Agree Disagree Strongly Disagree

I learned practical information in this session Strongly Agree Agree Disagree Strongly Disagree

I participated in this session Strongly Agree Agree Disagree Strongly Disagree

I feel comfortable in this group Strongly Agree Agree Disagree Strongly Disagree

Is there content you thought that should have been covered better? Please specify what you think should be covered better:

Is there anything else you’d like us to know regarding the session? Yes No

Please tell us what you think:

THANK YOU VERY MUCH!!