Annual Feedback Survey - Crossroads4Hope

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As a valued member at Crossroads4Hope, we want to hear about your experience in our programs. Your feedback will help us improve our programs and sustain our ability to continue serving the community in the best way possible.

Personal Information

How are you impacted by cancer?*

I am a person with cancer.

I am now post-treatment (no evidence of disease).

I am a spouse/life partner of a person with cancer.

I am a family member (non-spouse) of a person with cancer.

I am a friend of a person with cancer.

I am a bereaved person who had a recent loss of a loved on.

What is your primary cancer diagnosis or that of your family member/friend?*

Other Cancer Type*

Please describe

How long have you been participating in Crossroads4Hope programs?*

Less than 6 months

6 months – 2 years

2 – 6 years

More than 6 years

Overall, how supported do you feel by Crossroads4Hope?*

(1= Not Supported, 5= Very Supported)

Crossroads4Hope Experience

Please rate your experience in areas listed below.
(1=Poor, 5=Outstanding)

Variety of Programs*

Quality of Programs*

Delivery of Programs*

Please check all Crossroads4Hope programs you have attended in the last year*

Mind-Body Classes

Support Groups

Educational Workshops

Nutrition Workshops

MyGo2Support

Individual Support, including referral/navigation for resources

Social Programs, including Creative Arts

How has Crossroads4Hope impacted your life?*

(Check all that apply)

You selected "Other", please specify:*

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Mind and Body Programs

Have you attended any Mind and Body programs in the last year?*

(i.e., Yoga, T’ai Chi Chih, Move & Tone, etc.)

Yes

Please rate your experience in our Mind & Body programs (i.e., Yoga, T’ai Chi Chih, Move & Tone, etc.) for the areas listed below.
(1 = Strongly Disagree, 5 = Strongly Agree)

Learn new ways to manage stress*

Keep or improve my physical abilities*

Improve my balance and lower the risk of falling*

Reduce the impact from side effects*

Improve my self-esteem*

Improve my sleep*

Reduce feelings of anxiety and depression*

Increase social / emotional support*

What other Mind & Body programs would you like to see on our calendar?*

Education and Nutrition Workshops

Have you attended any Education or Nutrition Workshops with Crossroads4Hope in the last year?*

Yes

Please rate your experience at Education and Nutrition Workshops at Crossroads4Hope in the areas listed below.
(1 = Strongly Disagree, 5 = Strongly Agree)

I have gained the knowledge that I was seeking*

The information presented was at an appropriate educational level*

I have met others with similar interests / concerns*

I feel comfortable asking the presenters questions*

What other education or nutrition topics would you like to see?*

Crossroads4Hope Support

Have you received Individual Support from a Crossroads4Hope team member?*

Yes

Individual Support at Crossroads4Hope has helped me: *
(Please rate the statements below from 1 = Strongly Disagree to 5 = Strongly Agree.)

By reducing feelings of loneliness*

With physical symptom management*

Learn new coping mechanisms*

Increase my awareness of educational tools*

Increase my access to additional organization/providers*

Have you attended any Crossroads4Hope support groups in the last year?*

Yes

Please rate your Crossroads4Hope support group experience in the areas listed below.
(1 = Strongly Disagree, 5 = Strongly Agree)

I feel safe to talk openly*

I feel connected with others*

I learn about myself*

I learn about the cancer experience*

I feel supported by the group*

The facilitator helps the group stay focused*

The facilitator helps the group talk about deeper issues*

Overall the facilitator does a good job*

Are you enrolled in our MyGo2Support program?*

Yes

I am not familiar with MyGo2Support

Please rate your experience with the MyGo2Support program?*

(1= Poor, 5 = Outstanding)

How have you found the MyGo2Support weekly check ins to be helpful?*

How has MyGo2Support program been beneficial in your cancer experience?*

(Check all that apply)

I feel less isolated and more connected to a community

I have improved my communication/relationship with my healthcare team

I feel connected to the additional programs at Crossroads4Hope

I am more connected to relevant resources in the community

I feel less anxious and depressed

I feel more educated about my diagnosis and treatment

Support4Families

Have you received support from our Support4Families team (our Certified Child Life Specialists)?*

Yes

The Support4Families team at Crossroads4Hope has helped me:
Please rate the statements below from 1 = Strongly Disagree to 5 = Strongly Agree.

By reducing my feelings of loneliness*

Improve my ability to educate my kids about cancer in a way they understand*

By educating me on what to expect from my children’s developmental needs, responses, and behaviors*

Improve my ability to parent through the cancer journey*

By offering myself or my child opportunities for emotional expression*

Improve my family’s communication*

The facilitator helps the group talk about deeper issues*

What programs would you like to see added to our calendar for children, teens, young adults, or parents?*

Program and Communication Preferences

I prefer to attend Crossroads4Hope programs:*

In-person

Virtual (via Zoom)

Both (in-Person & Zoom)

What is your preferred way of staying connected with Crossroads4Hope?*

Text Message

Phone Call

Mail

Zoom/Virtual Meetings

Social Media

Website

Do you use the Crossroads4Hope website to learn more about our programs and services?*

Yes

Please rate your ability to find the information you were looking for*

(1= not able, 5 = very able to)

How did you initially hear about Crossroads4Hope?*

You chose "Other", please specify:*

Do you follow us on social media (Facebook, Instagram, Twitter, etc.)?*

Yes

Which social media platforms do you follow us on?*

(Check all that apply)

Instagram

Facebook

YouTube

How frequently would you prefer to receive program related communications from Crossroads4Hope?*

When you think of Crossroads4Hope, what words come to mind?*

Please feel free to use this space to expand further on any feedback.

If you would like a member of the Crossroads4Hope team to follow up with you about any of the feedback you shared, please add your name and preferred contact information here:

We’d love to hear your thoughts!

Personal Information

Crossroads4Hope Experience

Section Break

Mind and Body Programs

Education and Nutrition Workshops

Crossroads4Hope Support

Support4Families

Program and Communication Preferences