Dartmouth : Seminar I Evaluation Form

Please take a few minutes to evaluate today's workshop.
Scale: 1=Yes, definitely 2=Yes, a lot 3=Yes, somewhat 4= Hardly at all 5=No, definitely not

SYMPTOMS OF DISEASE/TREATMENT AND THEIR MANAGEMENT

Are you currently experiencing symptoms, which concern you?	1	2	3	4	5
Will the information provided be useful in managing these symptoms?	1	2	3	4	5
Will you talk to your healthcare providers about your symptoms?	1	2	3	4	5
Will you talk to your family/friends about your symptoms?	1	2	3	4	5

SENSE OF CONTROL

Do you feel in control of your life today?	1	2	3	4	5
Did this workshop give you skills to feel more in control?	1	2	3	4	5
Will you discuss personal control issues with your health care providers?	1	2	3	4	5
Will you discuss personal control issues with your family/friends?	1	2	3	4	5

FEEDBACK

Do you feel the information given today was useful?	1	2	3	4	5
Do you feel the discussion among participants was useful?	1	2	3	4	5

COMMENTS:

Date:________________

Patient

Support Person

Name (optional):____________________

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This content is derived from the "Charting Your Course Seminars: A Whole Person Approach To Living With Cancer", provided by Norris-Cotton Cancer Center.