Tell Us About Your Experience By answering these questions, you provide the Indiana Medical History Museum with important data about out visitors that helps us plan for future programming.
How would you rate the quality of your experience today? Excellent Good Average Below Average Poor
How much do you agree with the following statement: This visit was stimulating. Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree Comments? _
How likely are you to recommend IMHM to a friend? Highly likely Somewhat Likely Not likely or unlikely Somewhat Unlikely Highly unlikely Comments?
What types of IMHM programs interest you? Talks Multimedia performances Music Other Comments?
How did you hear about this program? IMHM Website IMHM Social Media Family/Friend Newspaper Other Please explain:
How many programs at IMHM do you attend a year? 0-1 2-3 4-5 6+
How likely are you to come back for another visit within the next year? Highly likely Somewhat Likely Neither likely or unlikely Somewhat unlikely Highly Unlikely Comments?
Did you feel the ticket price of today’s admission was: Too low Reasonable Too high Comments?:_
Are you an IMHM Member? Yes No Not sure
Suggestions for future programs (or any additional comments): _
Gender: Male Female Prefer not to answer
Age: Under 18 18-24 35-44 45-54 55-64 65-74 75 and older Prefer not to answer
Race/ Ethnicity: Asian Black/African American Caucasian Hispanic/ Latino Multi-Racial Native American/ Alaska Native Native Hawaiian/ Pacific Islander Prefer not to answer _
Household Income: Less than 30,000 30,000-59,999 60,000-89,999 90,000-119,999 More than 120,000 Prefer not to answer
What is the highest level of education you have completed? Some high school High school/ GED Some college 2-year college degree (Associate) 4 Year college degree (Bachelor) Master’s Degree Professional Degree (i.e. MD/JD) Doctoral Degree (PhD) Prefer not to answer
By answering these questions, you provide the Indiana Medical History Museum with important data about out visitors that helps us plan for future programming.
How would you rate the quality of your experience today?
Excellent
Good
Average
Below Average
Poor
How much do you agree with the following statement: This visit was stimulating.
Strongly agree
Agree
Neither agree nor disagree
Disagree
Strongly disagree
Comments? _
How likely are you to recommend IMHM to a friend?
Highly likely
Somewhat Likely
Not likely or unlikely
Somewhat Unlikely
Highly unlikely
Comments?
What types of IMHM programs interest you?
Talks
Multimedia performances
Music
Other
Comments?
How did you hear about this program?
IMHM Website
IMHM Social Media
Family/Friend
Newspaper
Other Please explain:
How many programs at IMHM do you attend a year?
0-1
2-3
4-5
6+
How likely are you to come back for another visit within the next year?
Highly likely
Somewhat Likely
Neither likely or unlikely
Somewhat unlikely
Highly Unlikely
Comments?
Did you feel the ticket price of today’s admission was:
Too low
Reasonable
Too high
Comments?:_
Are you an IMHM Member?
Yes
No
Not sure
Suggestions for future programs (or any additional comments):
_
Gender:
Male
Female
Prefer not to answer
Age:
Under 18
18-24
35-44
45-54
55-64
65-74
75 and older
Prefer not to answer
Race/ Ethnicity:
Asian
Black/African American
Caucasian
Hispanic/ Latino
Multi-Racial
Native American/ Alaska Native
Native Hawaiian/ Pacific Islander
Prefer not to answer
_
Household Income:
Less than 30,000
30,000-59,999
60,000-89,999
90,000-119,999
More than 120,000
Prefer not to answer
What is the highest level of education you have completed?
Some high school
High school/ GED
Some college
2-year college degree (Associate)
4 Year college degree (Bachelor)
Master’s Degree
Professional Degree (i.e. MD/JD)
Doctoral Degree (PhD)
Prefer not to answer
What is your zip code?