Living Well Class Completion Survey
*
1.
First Name
(Required.)
*
2.
Last Name
(Required.)
*
3.
What is your 6-Digit Employee Identification Number?
(SLCo Employee = EIN; SLCo Employee Designee = EIN + 1)
(Required.)
*
4.
Please select:
(Required.)
Male
Female
Non-binary
Prefer not to say
Prefer to self-describe
*
5.
Your age group:
(Required.)
Under 18
18-24
25-34
35-44
45-54
55-64
65+
*
6.
Are you a current Healthy Lifestyles participant?
(Required.)
Yes
No
*
7.
What is the name of the class that you enrolled in?
(Required.)
Walk With Ease
EnhanceFitness
Living Well with Diabetes
Living Well with Chronic Conditions
Tai Chi for Arthritis
Living Well with Chronic Pain
Stepping On
Other (please specify)
*
8.
What is the
main
reason you registered for a Living Well Class?
(Required.)
Motivation to move
Have fun
Learn something new
Help better my current health condition
Support someone who deals with a chronic health condition
Trying to figure out how to deal with a recent diagnosis
Other (please specify)
9.
What format was the class held in that you attended?
In-person
Online
Hybrid
Self-Lead
10.
Did you like the format that which the program was conducted and why?
*
11.
How would you rate your experience with the Living Well Class?
(Required.)
Very Dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied
Satisfied
Very Satisfied
Class Time
Very Dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied
Satisfied
Very Satisfied
Class Instructor
Very Dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied
Satisfied
Very Satisfied
Education and materials that were taught and provided
Very Dissatisfied
Dissatisfied
Neither satisfied nor dissatisfied
Satisfied
Very Satisfied
Comments:
*
12.
In your opinion, did attending the class have any positive effect on your health?
(Required.)
Yes
No
If yes, what was the positive effect that the class had?
13.
On a scale of 1-5 (1 being not likely and 5 being very likely), how likely are you to apply any information you learned during this program?
1 smiley
2 smileys
3 smileys
4 smileys
5 smileys
14.
What did you learn from attending the Living Well class?
*
15.
Is there anything that you disliked from the class that you attended?
(Required.)
Current Progress,
0 of 15 answered