Information Services Evaluation Form

First Name

Last Name

Phone

Zip Code

What is your relationship to epilepsy?

I have epilepsy/seizuresMy child has epilepsy/seizuresMy parent has epilepsy/seizuresMy spouse or partner has epilepsy/seizuresAnother family member has epilepsy/seizuresA friend/co-worker has epilepsy/seizuresI work with people who have epilepsy/seizuresOther/prefer not to respond

Information Services Evaluation

Date of Contact:

Type of Contact:

	Agree	Somewhat Agree	Neutral	Somewhat Disagree	Disagree
I learned information that will help me manage life with epilepsy.
I learned about resources that will help me manage life with epilepsy.
My knowledge of epilepsy and seizures increased.
If needed, I will seek information or support from the Epilepsy Foundation of Minnesota again.
I felt comfortable asking questions and sharing personal information.
I was provided the information and/or resources I needed.

Additional thoughts/comments:

How did you hear about Information Services?

Please specify:

Contact Information

Connect Groups

Connect Groups are an easy way to meet people affected by epilepsy and share experiences in a safe and supportive environment. The structure and intent of Connect Groups vary by location to meet the needs of that community.

More Information

Epilepsy Foundation of Minnesota appoints Jenna Carter as new Executive Director.