Participant Survey for Cancer Support Services Program

In order to help ensure that we are meeting your needs, we appreciate you taking a few minutes to complete the questions below. Your feedback is anonymous and will help Taos Cancer Support Services (TCSS) improve our quality of service.

Please check the box that best reflects your beliefs about each statement. *

	Strongly Disagree	Disagree	Agree	Strongly Agree
I have received useful information and resources from this program.	I have received useful information and resources from this program. Strongly Disagree	I have received useful information and resources from this program. Disagree	I have received useful information and resources from this program. Agree	I have received useful information and resources from this program. Strongly Agree
This program provides quality services.	This program provides quality services. Strongly Disagree	This program provides quality services. Disagree	This program provides quality services. Agree	This program provides quality services. Strongly Agree
This program provides services in a timely manner.	This program provides services in a timely manner. Strongly Disagree	This program provides services in a timely manner. Disagree	This program provides services in a timely manner. Agree	This program provides services in a timely manner. Strongly Agree
This program overall has helped to reduce my stress.	This program overall has helped to reduce my stress. Strongly Disagree	This program overall has helped to reduce my stress. Disagree	This program overall has helped to reduce my stress. Agree	This program overall has helped to reduce my stress. Strongly Agree
This program offers helpful services and resources.	This program offers helpful services and resources. Strongly Disagree	This program offers helpful services and resources. Disagree	This program offers helpful services and resources. Agree	This program offers helpful services and resources. Strongly Agree
This program has helped me cope with my situation.	This program has helped me cope with my situation. Strongly Disagree	This program has helped me cope with my situation. Disagree	This program has helped me cope with my situation. Agree	This program has helped me cope with my situation. Strongly Agree
The program has provided opportunities to strengthen my support systems.	The program has provided opportunities to strengthen my support systems. Strongly Disagree	The program has provided opportunities to strengthen my support systems. Disagree	The program has provided opportunities to strengthen my support systems. Agree	The program has provided opportunities to strengthen my support systems. Strongly Agree
The stress of my financial burden has been reduced due to the assistance from this program.	The stress of my financial burden has been reduced due to the assistance from this program. Strongly Disagree	The stress of my financial burden has been reduced due to the assistance from this program. Disagree	The stress of my financial burden has been reduced due to the assistance from this program. Agree	The stress of my financial burden has been reduced due to the assistance from this program. Strongly Agree
The massage and/or acupuncture treatments (if received) have improved my sense of well-being.	The massage and/or acupuncture treatments (if received) have improved my sense of well-being. Strongly Disagree	The massage and/or acupuncture treatments (if received) have improved my sense of well-being. Disagree	The massage and/or acupuncture treatments (if received) have improved my sense of well-being. Agree	The massage and/or acupuncture treatments (if received) have improved my sense of well-being. Strongly Agree
I would recommend this program to others.	I would recommend this program to others. Strongly Disagree	I would recommend this program to others. Disagree	I would recommend this program to others. Agree	I would recommend this program to others. Strongly Agree
Overall, the program has helped improve my quality of life	Overall, the program has helped improve my quality of life Strongly Disagree	Overall, the program has helped improve my quality of life Disagree	Overall, the program has helped improve my quality of life Agree	Overall, the program has helped improve my quality of life Strongly Agree

Other Comments?

Who was your CSS Facilitator

Please rate the performance of your CSS Support Group facilitator by choosing one rating for each item below:

	1 - Poor	2	3	4	5 - Excellent
Respectfully listened to participants.	Respectfully listened to participants. 1 - Poor	Respectfully listened to participants. 2	Respectfully listened to participants. 3	Respectfully listened to participants. 4	Respectfully listened to participants. 5 - Excellent
Encouraged participation from all group members.	Encouraged participation from all group members. 1 - Poor	Encouraged participation from all group members. 2	Encouraged participation from all group members. 3	Encouraged participation from all group members. 4	Encouraged participation from all group members. 5 - Excellent
Respected group members’ needs and differences.	Respected group members’ needs and differences. 1 - Poor	Respected group members’ needs and differences. 2	Respected group members’ needs and differences. 3	Respected group members’ needs and differences. 4	Respected group members’ needs and differences. 5 - Excellent
Overall	Overall 1 - Poor	Overall 2	Overall 3	Overall 4	Overall 5 - Excellent

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