JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Event Interest Survey
The Public Health Museum wants to hear from you about what events and programming you would like to see offered in 2021.
If you have any additional comments or questions, please feel free to email
info@publichealthmuseum.org
.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Have you attended a museum event before?
*
Yes
No
Maybe
Do you prefer a morning, afternoon, or evening event?
*
Morning
Afternoon
Evening
Other:
Required
Which of these topics interests you most?
*
Pandemics
Infectious Disease (Smallpox, Tuberculosis, Polio, etc.)
Information about Covid-19
Mental Health
History of Tewksbury Hospital & other state hospitals
Nursing
Dentistry
Current Events in Public Health
Vaccinations
Environmental Health
Epidemiology
Other:
Required
Are there other events or topics you would be interested in the Museum offering?
Your answer
Do you have any speakers you would like to suggest for future Museum events?
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Public Health Museum in Massachusetts.
Report Abuse
Forms