California Heart Connection Picnic Survey
There are some error(s). Please see each marked section below.
1.
If you attended previous picnics, how did you learn about them?
Hospital
Hospital
Physician's office
Physician's office
CA Heart Connection website
CA Heart Connection website
CA Heart Connection emails
CA Heart Connection emails
Friend
Friend
Other
2.
Please rate the reasons you came to past picnics or the reasons you would attend future picnics.
Least Important
Most Important
Meeting other families and children with CHD
Meeting adults with CHD
Getting information and resources
Enjoying the activities and music
Seeing physicians and other medical personnel
Comment:
500 character(s) left.
3.
If you attended previous picnics, how satisfied were you with the event?
Very satisfied
Very satisfied
Somewhat satisfied
Somewhat satisfied
Neutral
Neutral
Somewhat dissatisfied
Somewhat dissatisfied
Very dissatisfied
Very dissatisfied
Comment:
500 character(s) left.
4.
Please indicate the importance of the following when considering attending our picnic.
Very Unimportant
Somewhat Unimportant
Neutral
Somewhat Important
Very Important
Location
Price or donation amount
Information/resources provided at the event
Ease of transportation or parking
Ease of meeting other families or adults with CHD
Types of activities (please list those you would like in comments)
Food
Comment:
500 character(s) left.
5.
If we provide information booths at the picnic, which topics would you be most interested in?
Least Interested
Most Interested
CPR and AED's
Heart Valves
Pacemakers and defibrillators
Heart Camps
Heart Transplants
Medications
School Information (504 plans and IEP's)
Diet/nutrition for those with CHD
Feeding tubes
Other (please add to comments below)
Comment:
500 character(s) left.
6.
What age is the CHD patient?
0-2
0-2
3-5
3-5
6-10
6-10
11-15
11-15
16-20
16-20
21-30
21-30
31-40
31-40
41 or older
41 or older
Comment:
500 character(s) left.
7.
How far have you traveled (or would you travel) for our picnic?
Less than 10 miles
Less than 10 miles
10-30 miles
10-30 miles
30-50 miles
30-50 miles
50 - 70 miles
50 - 70 miles
70 plus miles
70 plus miles
8.
We may reserve a block of hotel rooms at a discount for the picnic. If you would be interested in staying at a local hotel, what is the
maximum price range
would you be willing to pay?
Not interested in a hotel
Not interested in a hotel
Less than $75
Less than $75
$75 to $100
$75 to $100
$100 to $125
$100 to $125
$125 or more
$125 or more
9.
Which things are most important to you in a hotel (if you would consider staying overnight.)
Least Important
Most Important
Price
Proximity to the picnic
Room Size (sleeps at least 4)
Amenities: pool, room service, breakfast, etc.
Other (please add comment)
Comment:
500 character(s) left.
10.
Our 10th Annual Picnic is scheduled for Saturday, June 5th, 2010 from 11am - 3pm at the Santa Ana Zoo (located in Orange County, CA).
How likely is it that you will attend?
Not likely
Not likely
Possible - we'll try to make it
Possible - we'll try to make it
Very likely - we'd love to come!
Very likely - we'd love to come!
Comment:
500 character(s) left.
11.
Do you have any media contacts that can help us get publicity for this event and/or general awareness of congenital heart defects?
Yes - see contact info in comments section
Yes - see contact info in comments section
Sorry - I don't
Sorry - I don't
Comment:
500 character(s) left.
12.
Do you have any suggestions for improving our Annual Picnics?
350 character(s) left.
Thank you for taking this survey - and for being a part of California Heart Connection!
Please see our website for more information at www.caheartconnection.org