Love Your Liver Program Evaluation Form

*1.
Question - Required - Program Date:




*2.  


*3.  


*4.  


*5.
Question - Required - Rate your knowledge BEFORE this program:






*6.
Question - Required - Rate your knowledge AFTER this program:






*7.
Question - Required - How was the speaker?






*8.
Question - Required - How was the information in the presentation:






*9. What topics would you want to hear more about?
(Select one of the available choices or enter a different value.)



 

TELL US ABOUT YOU:

10.
Question - Not Required - How old are you?



11.
Question - Not Required - Gender:


12.
Question - Not Required - Race:








13.  


14.  


 

OFFICE USE ONLY

*15.


*16.  


   Please leave this field empty