Cancer Education Flip Chart Evaluation
Answers marked with a * are required.
1.
The information shared in the cancer education flip chart is helpful.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
2.
The flip chart makes it easier to talk about cancer screening exams to support wellness.
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
3.
I have read through the flip chart and will talk to my health care provider about my cancer screening exams
Yes
No
4.
How will you share this cancer education flip chart (mark all that apply)
With a patient
With my family
In a school presentation
At a health fair
At a community gathering
With CHA/P, BHA or other CME
Other
Other (Please Specify)
5.
What else would you like us to know about this Cancer Education Flip Chart?
6.
Your name and contact information
if you want CME credits for this
Name
Village
Email address
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