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* 1. Participant

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* 2. Today's Date

Date

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* 3. The screening event staff was friendly, courteous and professional.

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* 4. The screening event was organized and I knew exactly where to go for each station.

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* 5. The staff was knowledgeable and gave appropriate feedback related to my results.

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* 6. I feel comfortable about the confidentiality of my personal health results from the screening event.

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* 7. The screening event stayed on schedule with the expected time allotted.

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* 8. Overall, I was satisfied with my On-Site screening event experience.

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* 9. Additional comments:

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