Survey - PAMAS

Your Thoughts On The Film

Audience Thoughts about “Thoughts on Medical Assisted Suicide”

Thank you for viewing the film! Please take a few minutes to answer these questions:

1. On a scale of 1 to 4, with 1 meaning “nothing” and 4 meaning “a lot,” how much would you say that you knew about Medical Assisted Suicide and Euthanasia before viewing this film? Please select one:

1 Nothing 2 Very Little 3 A moderate amount 4 A lot

2. On a scale of 1 to 4, with 1 meaning “nothing” and 4 meaning “a lot,” how much would you say that you learned about Medical Assisted Suicide and Euthanasia from this film? Please select one:

1 Nothing 2 Very Little 3 A moderate amount 4 A lot

3. Did your opinion about legalization of Medical Assisted Suicide change because of viewing this film? Please select one:

Yes No

If yes, how did it change? (Please be specific).

4. What, in your opinion, were the film’s strong points? What could have been done better? (Please be specific.)

Demographic questions (Please select one.)

If other please specify:

How would you describe your ethnicity?

If Hispanic, Latinx, or Spanish origin please specify:

If from multiple races please specify:

If some other race please specify:

If other health insurance please specify:

Do you have a disability?

Yes No Prefer not to disclose

If other gender please specify:

How did you hear about today’s film?

Friend Social Media Library announcement Other (see below)

If other please describe:

Where are you from?

City or Town:

State or Province:

Country: