Boost 'em in the Back

EVMS
Department of Pediatrics
Division of Community
Health and Research

Promoting Booster Seat Use

Feedback Survey   

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1. Generally, to whom will you show the video (e.g., are you just downloading for yourself, or do you plan to show it to others such as parents, professionals, etc.)?


2. Do you think you will show the video to others?
      Yes     No


3. How often do you think you will show the video, and roughly how many people do you expect to reach in this manner (please give your best estimates for monthly or yearly planned use)?


4. If you are planning to show the video to others, can you describe the population (e.g., nurses, low-income families, etc.)?


Comments:


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