Kohler Feedback Form Contact InformationFirst Name*Last Name*Email* PhoneFacility Name*Program Date* MM slash DD slash YYYY How many residents were provided one-on-one programming?*Small Group SessionWas there a small group session?* Yes No If yes, for how many residents total?*If a small group session was provided, how long did it last?Additional InformationPlease comment on the location for most of the visits taking place. Resident rooms, common areas?*What was the response of the residents and/or family members?*PhoneThis field is for validation purposes and should be left unchanged.
