Your health records: the feedback sheet.

Anonymous and optional. Print one for each person, hand it out at the start and collect it, folded, at the end. Part A and Part B rate the same four statements, taken from what this session sets out to teach.

How to use it and count the answers: the feedback guide.

Moraph for Good · Reach

Your health records

Feedback · moraph.org/commons/sessions/reach/your-health-records

Anonymous and optional. Please don’t write your name or anything about yourself. Your sheet goes to the host of this session, who counts the answers to help make the sessions better.

Part A Before we start

How sure are you that you can do each of these today? Tick one box on each line.

Part A: how sure you are, one box for each line
Statement	Not at all sure	A little sure	Fairly sure	Very sure
1I can describe what is usually in a health record and which parts are worth asking for.
2I can write a clear request for my own records, in a letter, form or portal message.
3I can say what the law where I live allows, and where to complain if a request is ignored.
4I can check a record for mistakes and keep my copies safe.

Fold here, so your Part A answers are hidden. Fill in Part B at the end.

Part B After the session

Now that the session is over, how sure are you? Tick one box on each line.

Part B: how sure you are, one box for each line
Statement	Not at all sure	A little sure	Fairly sure	Very sure
1I can describe what is usually in a health record and which parts are worth asking for.
2I can write a clear request for my own records, in a letter, form or portal message.
3I can say what the law where I live allows, and where to complain if a request is ignored.
4I can check a record for mistakes and keep my copies safe.

Was the session clear?YesPartlyNo
Did anyone try to sell you something, or push you to do something?YesNo
What would you like a session on next?

Thank you. Hand this sheet back to the host, folded. Free to copy and adapt. moraph.org/commons/sessions/reach/your-health-records/feedback