Program tool 21 - Active Independent Aging

Resources > Program tools > Program tool 21

Program tool 21. Member satisfaction survey

Please help us improve our program (activity) by answering the following questions. We are interested in your honest opinion, whether positive or negative. Please answer all of the questions. We also welcome your comments and suggestions. Thank you very much. We really appreciate your help.

Circle your answers.

1. How would you rate the quality of the program?

Excellent Good Fair Poor

2. Was this the type of program you were looking for?

No, definitely not No, not really Yes, generally Yes, definitely

3. If friends were looking for a similar program, would you recommend this one to them?

No, definitely not No, not really Yes, generally Yes, definitely

4. In an overall, general sense, how satisfied are you with the program (activity)?

Quite dissatisfied Mildly dissatisfied Mostly satisfied Very satisfied

5. Would you sign up for this program again?

No, definitely not No, not likely Yes, probably Yes, definitely

Comments:

Active Independent Aging was a joint venture between the University of Ottawa and the Public Health and Long-term Care Branch, City Of Ottawa. For more information please visit our website at: www.falls-chutes.com. Funding provided by Health Canada/Veterans Affairs Canada Falls Prevention Initiative. The views expressed herein do not necessarily represent the official policies of Health Canada, Veterans Affairs Canada, the University of Ottawa and the Public Health and Long-term Care Branch, City Of Ottawa. The information in this handout is current as of 2004.

Program tool 20

Program tool 22

Last modified May 7, 2004