Date you attended Death Cafe *

MM

DD

YYYY

Overall, how would you rate this event?

5:= Excellent

4 = Good

3 = Neutral

2 = Could be better

1 = Poor

How comfortable did you feel during the Death Café?

5 = very comfortable

4 =

3 =

2 =

1 = very uncomfortable

How well did the structure of the discussion at the Death Café work?

5 = very well

4 =

3 =

2 =

1 = not well at all

Overall, how would rate you the facilitation of the event?

5: = excellent

4 =

3 =

3 =

1 = poor

Name - Optional

First Name

Last Name