Post-Intervention Evaluation Form
Please provide your honest feedback about your experience following the intervention. Your responses help us improve future services.
Your Name
*
First Name
Last Name
Date of Intervention
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Overall, how satisfied are you with the intervention?
*
1
2
3
4
5
How effective was the intervention in addressing your needs?
*
Not effective
1
2
3
4
Highly effective
5
1 is Not effective, 5 is Highly effective
How clearly was the intervention explained to you?
*
Not clear
1
2
3
4
Very clear
5
1 is Not clear, 5 is Very clear
How would you rate the facilitator(s)?
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Did the intervention help you make progress towards your goals?
*
Yes
Somewhat
No
Would you recommend this intervention to others?
*
Definitely
Probably
Not sure
Probably not
Definitely not
What aspects of the intervention worked well?
What could be improved for future interventions?
Submit Evaluation
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