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Name
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First Name
Last Name
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Email
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3
Age Group
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Under 10
10–13
☐ 14–17
18-34
35+
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4
Are you excited to be part of the first Netflix & Heal tonight?
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Yes!
I’m curious to see what it’s about
I’m just here for the movie
Not sure yet
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5
Entertainment:
What do movies usually mean to you?
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Escape from stress
Time with family/friends
Inspiration or motivation
A way to learn or relate to characters
Other
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6
Emotional Check-In:
If you could describe what you need most tonight (rest, laughter, connection, etc.), what would it be?
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7
Self-Reflection:
💭 What do you think this movie might teach you about being yourself or finding your place in the world?
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