BrainGuide Feedback Survey
1.
How helpful did you find BrainGuide?
Extremely helpful
Very helpful
Somewhat helpful
Not so helpful
Not at all helpful
2.
On a scale of 0 to 10,
How likely is it that you would recommend this service to a friend or colleague?
0 for Not at all likely, 10 for Extremely likely
Not at all likely
Extremely likely
0
1
2
3
4
5
6
7
8
9
10
3.
Please provide any suggestions for improvements that we could make to our service
4.
I used BrainGuide primarily
For myself
As a caregiver
5.
Which of the following things did you do in BrainGuide?
Complete a phone-based assessment
Visit the BrainGuide website
Complete a web-based assessment
Receive customized resources regarding brain health
6.
Was BrainGuide easy to use?
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
7.
Did BrainGuide provide you insights into Brain Health?
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
8.
Were the resources provided by BrainGuide relevant to you?
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
9.
After using BrainGuide, are you more likely to take action or do something differently to manage your Brain Health?
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
10.
BrainGuide helped me feel more confident / prepared to discuss brain health with my doctor
Very likely
Likely
Unlikely
Not Applicable
11.
What is your gender identity?
Female
Male
Transgender
Non-binary
Other/Not listed
Prefer not to respond
12.
Which of these best describes your race or ethnicity?
White or Caucasian
Black or African American
Hispanic or Latino
Asian or Asian American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Multiracial
Other/Not listed
Prefer not to respond
13.
What is your estimated annual household income?
Under $15,000
Between $15,000 and $29,999
Between $30,000 and $49,999
Between $50,000 and $74,999
Between $75,000 and $99,999
Between $100,000 and $150,000
Over $150,000
Prefer not to respond
14.
What is your age?
Under 20
21-30
31-40
41-50
51-60
61-70
71-80
81-90
91+
Prefer not to respond