Presentation Feedback Survey

Personal Information

First Name:
Last Name:
Street Address:
City:
State: Select One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code:
E-mail Address:

Are you an AAFP Member? Yes No
AAFP Member ID:
If you are not a current AAFP member, please select your occupation:
Select One Medical Student Physician Assistant Nurse Nurse Practitioner Other
If other, please specify:

How did you hear about the Ready, Set, FIT! program? Select One AIM Exhibit AIM Website AAFP Meeting AAFP Presentation AAFP News Article Promotional Flyer/Advertisement Recommended by Someone Link from Another Site Other
If other, please specify:

School you presented at:
Date of presentation:  (MM/DD/YYYY)

Presentation Feedback

1. In general, how closely did you follow the instructions in the Presenter's Guide?
Select One I followed them very closely I followed them somewhat closely I followed them loosely I did not follow them at all

2. How helpful did you find the Presenter's Guide?
Select One Very helpful Somewhat helpful Not very helpful Not helpful at all

3. Overall, how much did you like or dislike being a presenter for the Ready, Set, FIT! program?
Select One Liked very much Liked somewhat Disliked somewhat Disliked very much

4. How interested are you in being a presenter for this program in the future?
Select One Very interested Somewhat interested Not very interested Not interested at all

5. Would you recommend this presenter opportunity to another colleague?
Select One Definitely recommend Probably recommend Probably would not recommend Definitely would not recommend

6. What did you like most about the Ready, Set, FIT! presentation experience?

7. What would you change about the Ready, Set, FIT! presentation experience?

Thank you for completing the Ready, Set, FIT! program. As a thank you for your participation, we would like to send you a FREE pair of Thorlo walking socks. Please select what size you would like to receive.
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Women's size 9.5 - 11.5, Men's size 8.5 - 10
Women's size 12 and above, Men's size 10.5 - 11.5