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Participant End of Program Evaluation
Overall, rate your opinion of the Weigh To Go program:
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10
1 = Poor - 10 = Excellent
Rate your opinion of the program instructor:
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1 = Poor - 10 = Excellent
Did the Weigh To Go program make you feel better?
Yes
No
Did the Weigh To Go program make you more active?
Yes
No
Would you recommend the Weigh To Go program to others?
Yes
No
Describe one significant change in your lifestyle as a result of the program?:
What did you like best about the program?
What did you like the least about the program?
What was the most difficult part of the program?
What suggestions do you have to improve the program?
Please list any chronic diseases you have (diabetes, obesity, etc):
Did the program help you decrease the medication you take?
Yes
No
Are you continuing exercise on your own?
Yes
No
How did you first hear about the Weigh To Go program?:
Appointments are available:
Monday: 6:30am - 8:00pm
Tuesday: 6:30am – 7:00pm
Wednesday: 6:30am - 8:00pm
Thursday: 6:30am – 6:00pm
Friday: 6:30am - 8:00pm
Saturday: By Appointment