Form 1 NLM MedlinePlus Google Survey Instrument (screenshots)

NLM Google Survey for MedlinePlus Page Satisfaction Rating
One of the following sets of custom questions will be presented to the page visitor:
Question Set 1
1. How likely are you to recommend this page to someone else?
[Multiple choice]
a) Very likely
b) Somewhat likely
c) Not sure
d) Somewhat unlikely
e) Very unlikely

2. Please tell us why:
[Free text response]
Question Set 2
1. How helpful is this web page to you?
[5 star rating selection from “Not helpful” to “Very helpful”]

2. How can we improve this web page?
[Free text response]
Screenshot of the OMB Burden Statement included at the bottom of a MedlinePlus English Health Topic
page:

1

Screenshot of a sample site with the standard Google Survey:

Screenshot of the OMB Burden Statement included at the bottom of a NLM MedlinePlus English
encyclopedia article:

2