Dartmouth : Seminar II - 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

FINANCIAL ISSUES
Do you have financial questions? 12345
Are you more informed about where and how to get financial information? 12345
Do you feel better able to tackle financial issues? 12345
Will you discuss financial issues with your health care providers? 12345
Will you discuss financial issues with your family/friends? 12345


COMPLEMENTARY THERAPIES
Are you interested in using complementary therapies? 12345
Will the information provided today be useful to you? 12345
Will you discuss complementary therapies with your health care providers? 12345
Will you discuss complementary therapies with your family/friends? 12345


NUTRITION
Do you currently have questions about nutrition? 12345
Will it help you meet your nutritional needs? 12345
Will you discuss nutrition issues with your physician? 12345
Will you discuss nutrition issues with your family/friends? 12345


SUPPORT NETWORK
Do you have concerns about your support network? 12345
Was the exercise about your personal support network useful? 12345
Will you talk about your need for support with health care providers. 12345
Will you talk about your need for support with family/ friends? 12345


COMMUNITY RESOURCES
Do you have access to community resources? 12345
Will the information provided today be helpful in identifying and accessing community resources. 12345
Will you discuss your need for resources with your health care providers? 12345
Will you discuss your need for resources with your family/ friends? 12345


COMMENTS










Date:________________
Patient
Support Person
Name (optional):____________________


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