Leader Post-Walk Survey

Please have one leader from your chapter complete this survey after each walk to track attendance and share feedback with WWAD Headquarters.

Post Walk Survey – Leader

Chapter Number

Your Name

Your Email

Walk Details

Walk Date

Estimated Number of Participants

Including leaders, staff, volunteers, etc.

What type of walk event was this?

Walk with a Doc: doctor or advanced practice provider
Walk with a Future Doc: medical student
Just Walk: other licensed healthcare provider
Community Walking Club: no healthcare provider

Speaker/leader for this event

Health Topic that was discussed

Additional Feedback (Optional)

Attachments (Optional)

You can also email any attachments to contact@walkwithadoc.org after submitting this form.

Pictures

Maximum file size: 104.86MB

Paper Sign-In Sheets

Maximum file size: 104.86MB

Add these pictures to my webpage

No Yes

Email me a copy of this survey

No Yes

If you are human, leave this field blank.