First Name

Last Name

Which location did you attend the class?

Date of Class Attended

Don't worry if you can't remember the exact date

How did you first hear about a Look Good Feel Better class?

How satisfied were you with your LGFB Facilitator, how would you rate them in terms of professionalism, knowledge and approachable manner?

Please rate the degree to which you agree or disagree with each of the following statements

	Strongly Agree	Agree	Neither Agree nor Disagree	Disagree	Strongly Disagree
I felt my inner and outer confidence improve after the LGFB class?
My morale was lifted after the LGFB class
I was able to connect and share with women in a similar experience
The class gave me some helpful tips & tricks to cope during my treatment

Would you like to receive information about Look Good Feel Better activities and programmes

Overall Comments

Thank you for your time and also for being a part of the Look Good Feel Better community.