Look Good Feel Better Website Exit Survey Questions
RequiredRequired Question(s)
    
 
Required 1.
On a scale of 1-5 (1 being the lowest, 5 the highest), please rate the ease of navigation of the LGFB Website. (If your rating was a 1 or 2, please explain why)
1 2 3 4 5       
      
  • Comment:

  • 500 characters left.
Required 2.
On a scale of 1-5 (1 being the lowest, 5 the highest) please rate the helpfulness of the information on the website to (If your rating was a 1 or 2, please explain why):
 1 2 3 4 5 
You
For someone else going through cancer treatment
  • Comment:

  • 500 characters left.
3.
On a scale of 1-5 (1 being the lowest, 5 the highest), how helpful did you find the following information on the website?
 1 2 3 4 5 
Beauty Guide
Makeover Tool in Beauty Guide section
Program Finder
Programs
Volunteers
Donate
About LGFB
4.
If you are a cancer patient, please rate on a scale of 1 - 5 (1 being the lowest, 5 the highest) how likely it is that you will attend a Look Good Feel Better workshop in your community.
1 2 3 4 5       
      
5.
If you are not a cancer patient, please rate on a scale of 1 - 5 (1 being the lowest, 5 the highest) how likely it is that you will recommend a Look Good Feel Better workshop to someone you know.
1 2 3 4 5       
      
Required 6.
How did you hear about the Look Good Feel Better website?
Medical Professional
Family Member
Friend
Informational Brochure
Media
Other  
Required 7.
Are you a:
Cancer patient undergoing treatment
Cancer survivor
LGFB Volunteer
Friend or Family Member of a cancer patient
Healthcare provider
Media
Other  
8.
If you are currently cancer patient or cancer survivor for what type of cancer are you/were you being treated for?
Brain & Other Nervous system
Breast
Colon & Rectum
Hodgkin's Disease
Leukemia
Lung
Lymphoma
Melanoma of the Skin
Multiple Myeloma
Ovarian
Pancreas
Uterine of Endometrial
Other  
Required 9.
What is your gender:
Male
Female
10.
What is your ethnic background?
African American/Black
American Indian/Alaskan Native
Asian
Chicana or Mexican-American
Other Hispanic/Latina
Caucasian/White
Native Hawaiin or Pacific Islander
Prefer not to answer
Required 11.
How old are you?
13-17
18-21
22-34
35-44
46-54
55-64
65 and over
Required 12.
Are you interested in receiving other information from Look Good Feel Better either by email or mail (your information will kept confidential and not be shared with or sold to third parties, but will used by Look Good Feel Better to update you on new information, events, or program activities.) 
Yes
No
13.
If you are interested in receiving other information, please enter your information below:

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Home Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code: