First Name
Last Name
Email
Which
location
did you attend the class?
Please select...
National
Ashburton
Auckland Central
Auckland South
Auckland North Shore
Auckland West
Blenheim
Central Otago
Christchurch
Dannevirke
Dunedin
Gisborne
Hamilton
Hawera
Hawke's Bay
Invercargill
Kapiti Coast
Kerikeri
Masterton/Wairarapa
Nelson
New Plymouth
Oamaru
Paihia
Palmerston North
Queenstown
Rotorua
Taumarunui
Taupo
Tauranga
Te Anau
Thames
Timaru
Tokoroa
Wellington
West Coast Greymouth
West Coast Westport
Whakatane
Whanganui
Whangarei
Date of Class Attended
Don't worry if you can't remember the exact date
How did you
first hear
about Look Good Feel Better?
Please select...
Cancer Society
Facebook
Feel Better Month campaign
Former Patient
Friend or relative
Hairdresser or Stylist
Health Professional - Doctor
Health Professional - Nurse
Health Professional - Social Worker
Insurance Provider
LGFB Volunteer
Media
Other
Pharmacy
Previously Attended
Web Search
Wig Specialist
Did you have any
concerns before deciding to attend
a Look Good Feel Better class?
Please select...
Yes
No
How satisfied were you with the
registration process
?
Please select...
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
N/A
How satisfied were you with the
ability to find and access the class
?
Please select...
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
N/A
What did you think about the
structure and content
of the class?
Please select...
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
N/A
How satisfied were you with
complimentary pack
?
Please select...
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
N/A
How useful was the information provided in the class on each of these topics?
Very Useful
Useful
Of Little Use
Not Useful
N/A
Skincare
Hair Advice
Wellbeing Advice
Connection with Others
How satisfied were you with your
LGFB Facilitator
, how would you rate them in terms of professionalism, knowledge and approachable manner?
Please select...
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
N/A
Would you
recommend the class
to other men?
Please select...
1 - Unlikely
2
3
4
5
6
7
8
9
10 - Highly Likely
How would you
rate your overall experience
with Look Good Feel Better
Please select...
Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatisfied
N/A
Would you like to receive information about Look Good Feel Better activities and programs ?
Please select...
Yes
No
Overall Comments
Thank you for your time and also for being a part of the Look Good Feel Better community.