Form Center

2. 
3. Thank you for participating in the VIEWER ADVISORY PANEL for the VETERANS’ VOICES television show.
   
   This short Survey covers the episode titled “Stellate Ganglion Block” which first aired on Monday, October 15, 2018.
5. Email Address*
7. 1. How relevant was this show for you?
9. 2. What was the best part of the show?
11. 3. Which part of the show did you like the least?
13. Segment A
    -- Select One --12345

    Brief Video Clip explaining the history and procedure for the medical use of Stellate Ganglion Block (RATE FROM 1 TO 5 with 5 being the highest)
15. Segment B
    -- Select One --12345

    An interview on the topic “Stellate Ganglion Block” hosted by Nathan Johnson and Kevin Graves with guest Dr. Colin Fernandes. (RATE FROM 1 TO 5)
17. Segment C
    -- Select One --12345

    A continued discussion on Stellate Ganglion Block (SGB) with the addition of Dr. Shauna Springer to the panel. (RATE FROM 1 TO 5)
19. Segment D
    -- Select One --12345

    A short “Vet on the Street” segment with questions about the Space Force from Ryan Berg. (RATE FROM 1 TO 5)
21. Segment E
    -- Select One --12345

    Nathan and Kevin speak with Rick Burth, a Marine veteran who has received the SGB treatment. (RATE FROM 1 TO 5)
23. Segment F
    -- Select One --12345

    “A VETERAN’S VOICE” segment with Kira Serna interviewing Air Force veteran, Archie Smith. (RATE FROM 1 TO 5)
25. Overall Show
    -- Select One --12345

    Rate Overall Show: Your personal OVERALL RATING for the content of this particular show. (RATE FROM 1 TO 5)
27. Comments? (Optional)
    Add any comments you wish to make about the overall show or any particular segment.
29. If you missed this episode of VETERANS’ VOICES, you can watch it when it repeats on your local Cable TV station for the next 30 days (Mondays at 7:00 PM, Wednesdays at 11:00 PM and Saturday at 9:00 AM). You can also view this episode on your computer starting Wednesday, October 17th by clicking this link to get to the VETERANS’ VOICES website: http://www.contracosta.ca.gov/5163/Veterans-Voices
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field