Healthcare Pilot Evaluation Survey Form
Please complete this survey to help us evaluate the Healthcare Pilot Evaluation Survey Form. Your feedback is valuable for improving future programs.
Overall, how satisfied are you with the Healthcare Pilot Evaluation Survey Form?
*
1
2
3
4
5
How easy was it to access and use the Healthcare Pilot Evaluation Survey Form?
*
Very easy
Somewhat easy
Neutral
Somewhat difficult
Very difficult
How well did the pilot program meet your expectations?
*
Exceeded expectations
Met expectations
Did not meet expectations
Please rate the communication you received throughout the pilot program.
*
1
2
3
4
5
How would you rate the quality of care or service provided during the pilot?
*
1
2
3
4
5
Did you notice any improvements in your health or well-being as a result of participating in the pilot?
*
Significant improvement
Some improvement
No change
Not sure
Please indicate your agreement with the following statements about the pilot program.
*
Rows
Strongly agree
Agree
Neutral
Disagree
Strongly disagree
The pilot program was well organized
1
2
3
4
5
Staff were helpful and knowledgeable
6
7
8
9
10
Information provided was clear
11
12
13
14
15
I would recommend this program to others
16
17
18
19
20
What was the most valuable aspect of the pilot program for you?
What could be improved in future versions of the Healthcare Pilot Evaluation Survey Form?
Do you have any additional comments or suggestions regarding the Healthcare Pilot Evaluation Survey Form?
Submit Survey
Should be Empty: