Cincy Warmline

About When to Call Services Resources Survey Contact

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Survey

In an attempt to maximize our caller’s experience, we ask that you take a brief moment and share your experience with us. Please use this form to let us know if you had a positive experience or if you have a concern or complaint. If you would like us to contact you regarding your experience, please include your email and/or phone number. Thank you very much for your time and participation!

Date of call: Date of call

Time of call : Time of call :

Peer supporter name : Peer supporter name :

1. Was the call free of distractions? (radio, TV, other people) 1. Was the call free of distractions? (radio, TV, other people): Choose Option Below: 1 (Poor) 2 3 4 5 (Excellent)

Comments:: Comments:

2. Rate the level of focus and engagement of peer supporter. 2. Rate the level of focus and engagement of peer supporter.: Choose Option Below: 1 (Poor) 2 3 4 5 (Excellent)

Comments:: Comments:

3. Was the call answered in 3 rings? 3. Was the call answered in 3 rings? : Choose Option Below: Yes No

Comments:: Comments:

4. Did the peer supporter respect the boundaries on confidentiality? 4. Did the peer supporter respect the boundaries on confidentiality?: Choose Option Below: Yes No

Comments:: Comments:

5. Were you allowed to speak without undue interruption? 5. Were you allowed to speak without undue interruption? : Choose Option Below: Yes No

Comments:: Comments:

6. Did the peer supporter listen without being judgmental or critical? 6. Did the peer supporter listen without being judgmental or critical?: Choose Option Below: Yes No

Comments:: Comments:

7. Did the peer supporter speak in a warm and friendly manner? 7. Did the peer supporter speak in a warm and friendly manner?: Choose Option Below: Yes No

Comments:: Comments:

8. Did the call end on a positive note? 8. Did the call end on a positive note?: Choose Option Below: Yes No

Comments:: Comments:

9. Did the peer supporter use your name during the call? 9. Did the peer supporter use your name during the call? : Choose Option Below: Yes No

Comments:: Comments:

10. Summary of call and general impressions. : 10. Summary of call and general impressions.

(513) 621-WARM

info@cincywarmline.org

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