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THRIVING SURVIVOR ACTIVITY CLASSES: Forms

Thriving Survivor After-Class Reflection

Thanks for signing up for our Thriving Survivor Classes. This after-class reflection will allow for us to determine how effective and beneficial these classes are to you. We want to make these YOUR classes and help best serve you. We appreciate your time and energy.

Which class are you reflecting on:(Required)

Music Therapy

Adaptive Fitness

Drums Alive®

Mindfulness

Meaningful Day Program

What do you hope to gain from taking the class?

If unsure, what are your long-term goals? Where do you want to be 1 year from now?

How would you rate your facilitator on a number from 1-10?

1 being not so great, and 10 being great!

Please enter a number from 1 to 10.

Were you able to fill out the poll given out at the end of your session?

Yes

No

I'm not sure

Hidden

Would you say your mood or how you feel improved since before the class?

(1 being bad and 10 being good)

Please enter a number from 1 to 10.

Hidden

Now rate your mood after the class from 1-10?

(1 being bad and 10 being good)

Please enter a number from 1 to 10.

Hidden

Please rate how you felt physically before the class from 1-10?

(1 being bad and 10 being good)

Please enter a number from 1 to 10.

Hidden

Now rate how you feel physically after the class from 1-10?

(1 being bad and 10 being good)

Please enter a number from 1 to 10.

Hidden

Please rate how you felt socially before the class from 1-10?

(1 feeling alone/isolated and 10 feeling content)

Please enter a number from 1 to 10.

Hidden

Now rate how you feel socially after the class from 1-10?

(1 feeling alone/isolated and 10 feeling content)

Please enter a number from 1 to 10.

Would you say your mood or how you feel improved since before the class?

Yes, I feel better emotionally

Neutral, I feel the same

No, I feel worse

Would you say how you feel physically, your body, has improved since before the class?

Yes, I feel better physically

Neutral, I feel the same

No, I feel worse

Would you say how you feel socially or connected with others has improved since before the class?

Yes, I feel better connected

Neutral, I feel the same

No, I feel worse

Do you find the class beneficial or useful to you?

Yes

Neutral (not yes or no)

No

Are there any additional comments, feedback, or topics you'd like more in the group?

CAPTCHA

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919-833-9634 | 800-377-1464

3733 National Drive
Suite 115
Raleigh, NC 27612

bianc@bianc.net

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Unmasking Brain Injury

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The Unmasking Brain Injury Project promotes awareness and advocacy about brain injury. Upon request, each person living with brain injury receives and designs a mask to tell their individual journey. The masks are mounted and displayed statewide in the community.

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