LungXperience Staff & Volunteer Feedback Form

First name

Last name

Which event did you attend?

How did everything go with the event? Please share any problems you encountered or suggestions for improvement to the program (e.g., ran out of giveaways, public engagement, partners, setup/teardown, training, etc.)

What were the most common topics or questions you discussed with the public? Select all that apply

Lung cancer screening eligibilityHow to access screening locallySymptoms or early detection concernsInsurance or cost questionsStigma or misconceptions about lung cancerResources for patients, caregivers, or advocatesResearch or science questionsSmoking history questionsOther (please specify)

Other:

Please share anything memorable or meaningful you experienced during the event. This could include a powerful quote, story, reaction, or moment from a community member, partner, or fellow volunteer, or the impact the experience had on you. Please include brief context and exact quotes when possible.

Please provide names and information for any contacts made.

Contact 1

First name

Last name

Phone

Contact type (patient, industry, etc.)

What do they want follow-up on (patient activities, physician resources, sponsorship opportunities, etc.)?

Add another

Contact 2

First name

Last name

Phone

Contact type (patient, industry, etc.)

What do they want follow-up on (patient activities, physician resources, sponsorship opportunities, etc.)?

Add another

Contact 3

First name

Last name

Phone

Contact type (patient, industry, etc.)

What do they want follow-up on (patient activities, physician resources, sponsorship opportunities, etc.)?

Lead Source

Organization

FA Integration Rule