Journey To Wellness: Feedback Form

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Name (optional)

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Date of the Retreat You Attended

Please rate your overall experience at the retreat

	Poor	Fair	Good	Very Good	Excellent
How would you rate your overall experience at the retreat?	PoorHow would you rate your overall experience at the retreat? Poor	FairHow would you rate your overall experience at the retreat? Fair	GoodHow would you rate your overall experience at the retreat? Good	Very GoodHow would you rate your overall experience at the retreat? Very Good	ExcellentHow would you rate your overall experience at the retreat? Excellent
How would you rate the effectiveness of the support group sessions?	PoorHow would you rate the effectiveness of the support group sessions? Poor	FairHow would you rate the effectiveness of the support group sessions? Fair	GoodHow would you rate the effectiveness of the support group sessions? Good	Very GoodHow would you rate the effectiveness of the support group sessions? Very Good	ExcellentHow would you rate the effectiveness of the support group sessions? Excellent
How would you rate your experience with the gentle yoga session?	PoorHow would you rate your experience with the gentle yoga session? Poor	FairHow would you rate your experience with the gentle yoga session? Fair	GoodHow would you rate your experience with the gentle yoga session? Good	Very GoodHow would you rate your experience with the gentle yoga session? Very Good	ExcellentHow would you rate your experience with the gentle yoga session? Excellent
How would you rate the quality of the lunch provided?	PoorHow would you rate the quality of the lunch provided? Poor	FairHow would you rate the quality of the lunch provided? Fair	GoodHow would you rate the quality of the lunch provided? Good	Very GoodHow would you rate the quality of the lunch provided? Very Good	ExcellentHow would you rate the quality of the lunch provided? Excellent

What aspect of the retreat did you find most beneficial?

What could we have improved?

Would you attend again?

Yes
No
Undecided

Content

	Not At All Helpful	Somewhat Helpful	Slightly Helpful	Very Helpful	Extremely Helpful
How helpful were the discussions in addressing your emotional and psychological needs?	Not At All HelpfulHow helpful were the discussions in addressing your emotional and psychological needs? Not At All Helpful	Somewhat HelpfulHow helpful were the discussions in addressing your emotional and psychological needs? Somewhat Helpful	Slightly HelpfulHow helpful were the discussions in addressing your emotional and psychological needs? Slightly Helpful	Very HelpfulHow helpful were the discussions in addressing your emotional and psychological needs? Very Helpful	Extremely HelpfulHow helpful were the discussions in addressing your emotional and psychological needs? Extremely Helpful
How helpful was the yoga session in helping you relax and reduce stress?	Not At All HelpfulHow helpful was the yoga session in helping you relax and reduce stress? Not At All Helpful	Somewhat HelpfulHow helpful was the yoga session in helping you relax and reduce stress? Somewhat Helpful	Slightly HelpfulHow helpful was the yoga session in helping you relax and reduce stress? Slightly Helpful	Very HelpfulHow helpful was the yoga session in helping you relax and reduce stress? Very Helpful	Extremely HelpfulHow helpful was the yoga session in helping you relax and reduce stress? Extremely Helpful

Did you feel that the retreat provided a safe and supportive environment?

Yes
No
Undecided

Did you feel heard and supported during the support group sessions?

Yes
No
Undecided

Did you feel that the yoga session was appropriate for your physical condition?

Yes
No
Undecided

What suggestions do you have for improving the retreat? (additional topics or activities, etc…)

Is there anything else you'd like to share about your experience today?

253-200-5260

PO Box 26891 Federal Way, WA 98093