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Fall Prevention Class Evaluation

Submit Your Feedback

Please help us make our Stepping On workshops the best they can be by completing this evaluation and returning it to one of the Leaders. Thank you!

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Where did you attend our workshops?

Please rate the workshop location

The location of the workshop was convenient.

The classroom was comfortable and conducive to learning.

Other comments concerning the workshop location

Please rate the workshop leaders

Group leader 1 was knowledgeable.

Group leader 1 was prepared and organized.

Group leader 1 communicated workshop information effectively.

Our leaders appreciate your feedback. Do you have any other comments or suggestions concerning group leader 1?

Group leader 2 was knowledgeable.

Group leader 2 was prepared and organized.

Group leader 2 communicated workshop information effectively.

Our leaders appreciate your feedback. Do you have any other comments or suggestions concerning group leader 2?

What did you like best about the workshop?

What changes do you think would improve the workshop?

Other comments concerning the workshop.

If you did not attend all 7 sessions please check any reasons below that apply

I was ill or didn’t feel well

The workshop did not meet my needs

I had other commitments

Other

Other reason

Enter any other comments about the sessions.

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Before We Begin

Are you a current patient at Central Ohio Primary Care?

Please Note

This form is used for COPC's New Patient Placement team to help you find a new COPC doctor. It is not intended to request an appointment for a COVID-19 vaccination. Please click here to view the latest COVID-19 updates from COPC.

Yes

Patient Information

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Do you have a Medicare or Medicare Advantage plan?

Preferred Appointment Day

Preferred Appointment Time

Best Time to Call Day

Best Time to Call Time

Your Request Has Been Submitted

A member of our New Patient Placement team will call you within 1 business day to assist you with scheduling your appointment. Please wait for our team to contact you before arriving to your appointment. If you have questions prior to our phone call, please dial (614) 326-4646, Monday — Friday, 7:30am to 5:00pm.

Patient Details

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For Current Patients

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Are you a current patient at Central Ohio Primary Care?

Best Time For Us To Call You

Select a preferred time range that is most convenient for us to call you and schedule your appointment.

Preferred Day of Week

Monday

Tuesday

Wednesday

Thursday

Friday

No Preference

Preferred Time

For Current Patients

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New Patients can either self schedule if it an option or request an appointment and our scheduling offices will contact you.

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Self Scheduling

Established Patient Scheduling

Existing patients can either schedule an appointment through MyChart or call the physicians office for scheduling.

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Fall Prevention Class Evaluation

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