Lupus and Related Autoimmune Diseases Action Workshop
August 30, 2019 Survey
Please share your feedback regarding our recent meeting. We appreciate your candid responses.
*
1.
Your Name
(Required.)
*
2.
Email Address
(Required.)
*
3.
Cell Phone Number
(Required.)
*
4.
Please provide the name of your organization
(Required.)
*
5.
Which sector(s) do you represent?
(Required.)
Academic Research
School Health
Non-profit
Healthcare
Policy
Clinical Care (MD, RN, PA, NP, etc.)
Other
*
6.
Before the workshop, how familiar were you with the Georgia Council on Lupus Education and Awareness?
(Required.)
Extremely familiar
Very familiar
Somewhat familiar
Not at all familiar
7.
What questions do you have about GCLEA that were not addressed during the Workshop?
*
8.
After attending this workshop, my knowledge of the state of Lupus in Georgia has.
(Required.)
Increased
Remained the same
9.
Overall, how satisfied were you with this Workshop?
Extremely satisfied
Somewhat satisfied
Neither satisfied or dissatisfied
Somewhat dissatisfied
Extremely dissatisfied
10.
How satisfied were you with the location and facilities of the Workshop?
Extremely satisfied
Somewhat satisfied
Neither satisfied or dissatisfied
Somewhat dissatisfied
Extremely dissatisfied
11.
How satisfied were you with the food and beverages?
Extremely satisfied
Somewhat satisfied
Neither satisfied or dissatisfied
Somewhat dissatisfied
Extremely dissatisfied
12.
How satisfied were you with the date and time of the Workshop
Extremely satisfied
Somewhat satisfied
Neither satisfied or dissatisfied
Somewhat dissatisfied
Extremely dissatisfied
13.
Any suggestions on how we can make the next Workshop better?
*
14.
Please rate your interest in future collaboration in the following GCLEA Workgroups:
(Required.)
Extremely likely
Very likely
Somewhat likely
Not at all likely
Public Outreach & Education
Extremely likely
Very likely
Somewhat likely
Not at all likely
Research
Extremely likely
Very likely
Somewhat likely
Not at all likely
Provider Outreach, Education & Support
Extremely likely
Very likely
Somewhat likely
Not at all likely
Patient Services & Resources
Extremely likely
Very likely
Somewhat likely
Not at all likely
Workforce Development
Extremely likely
Very likely
Somewhat likely
Not at all likely
15.
Please provide any additional comments/feedback to advance the work of the Georgia Council on Lupus Education and Awareness. Include your name and contact information if you would like us to respond to you directly.
16.
Would you be willing to provide contact information for additional stakeholders who may be interested in receiving information about the GCLEA and our meetings in the future?
If so, please enter their names and emails below:
