JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Walk with a Doc Post-Event Survey
Thank you for hosting a Walk with a Doc event! Please have your chapter leader complete the survey below after each walk and let us know if there's anything we can do to help support you for the next event!
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Your Name
Your answer
Chapter Number
*
Your answer
Walk Date
*
Please include the full year (ie type 2023 instead of 0023)
MM
/
DD
/
YYYY
Number of Participants
*
Including leaders, staff, volunteers, etc.
Your answer
Speaker/leader for this event
Please include the first name, last name, and credentials of the healthcare provider(s) who gave the health talk at this particular event. e.g. "John Smith, MD"
Your answer
Health Topic
Your answer
Please provide any additional feedback: good or bad!
Your answer
Thanks for completing this survey! After hitting "submit" below, please email
contact@walkwithadoc.org
or call 614-714-0407 with any questions, website updates, or anything we can do to help support you. We're excited for your next walk!
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Walk with a Doc.
Report Abuse
Forms
