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MS Awareness Month 2025/Shop Chats Feedback Survey
1.
Name (first and last)
2.
Email
*
3.
How did you learn about We Are ILL’s MS Awareness Month campaign, Shop Chats?
(Required.)
We Are ILL’s newsletter
We Are ILL’s website
We Are ILL’s Instagram account
We Are ILL’s Facebook account
A friend/family member
My hairstylist/salon
Someone I follow on Instagram
Other
4.
Name of Salon/Hairstylist (If you choose Salon/Hairstylist in Q3)
5.
Name of Instagram account (If you choose Instagram in Q3)
*
6.
Did you watch the panel discussion video?
(Required.)
Yes
No
7.
Did you read or receive the informational pamphlets?
Yes
No
*
8.
Prior to engaging with We Are ILL’s MS Awareness Month campaign, were you familiar with the organization?
(Required.)
Yes
No
*
9.
Before engaging with this campaign, how familiar were you with multiple sclerosis (MS)?
(Required.)
Not familiar at all
Somewhat familiar
Very familiar
After engaging with this campaign, how would you rate your understanding of the following topics? (Rate each on a scale of 1–5, where 1 = No understanding and 5 = Strong understanding)
*
10.
Symptoms and impact of MS
(Required.)
*
11.
Disparities in MS diagnosis and care in the Black community
(Required.)
*
12.
The role of organizations like ours in supporting people with MS
(Required.)
*
13.
Do you have a personal connection to multiple sclerosis (MS)?
(Required.)
Yes
No
I’m not sure.
14.
What is your connection to MS?
I’m living with MS.
My child has MS.
My parent has MS.
My spouse/partner/significant other has MS.
My family member/friend/loved one has MS.
I’m a caregiver.
I’m an industry professional or healthcare provider.
15.
Did you find the hair salon setting for the panel discussion relatable or impactful? Why or why not?
16.
On a scale of 1–5, how engaging did you find the panel discussion video? 1 = Not engaging at all, 5 Extremely Engaging
17.
Did the informational pamphlets provide clear and useful information?
Yes
No
N/A — I didn't receive the pamphlet
Somewhat (please explain):
*
18.
How relevant and informative did you find the content of We Are ILL’s MS Awareness Month campaign?
(Required.)
Extremely relevant and informative
Very relevant and informative
Somewhat relevant and informative
Not so relevant and informative
Not at all relevant and informative
*
19.
As a result of this campaign, are you more likely to do any of the following? (Select all that apply):
(Required.)
Talk to someone about MS
Look for more information about MS
Share campaign materials with others
Seek support or resources related to MS
None of the above
*
20.
Having engaged with this campaign, how likely are you to seek a second opinion or speak to a medical professional about your symptoms for a potential diagnosis?
(Required.)
Extremely likely
Very likely
Somewhat likely
Not so likely
Not at all likely
*
21.
Do you feel more confident advocating for or supporting someone with MS after engaging with this campaign?
(Required.)
Yes
No
I’m not sure
22.
After watching the panel discussion, do you feel more empowered to seek a healthcare provider that is a better fit for your needs?
Yes, I feel more confident.
I’m not sure, but I’ll consider it.
No, I didn’t feel this was addressed.
23.
What is one thing you learned from this campaign that you didn’t know before?
24.
Do you have any additional feedback about the campaign?
*
25.
Do you currently live with any medical conditions? If so, please list the condition(s) below.
(Required.)
Yes
No
26.
Medical condition(s) you currently live with.
*
27.
What’s your age range? (multiple choice, required response)
(Required.)
18-24
25-34
35-44
45-54
55-64
65-80+
*
28.
How would you describe your race or ethnicity? Please select all that apply.
(Required.)
Black/African American
Hispanic/Latino
American Indian/Alaska Native
Asian, Pacific Islander or Native Hawaiian
White
Some other race or ethnicity (please specify)
*
29.
Where are you located (please provide zip code)?
(Required.)
*
30.
Would you like to be added to We Are ILL’s mailing list?
(Required.)
Yes
No
