Survey - Cincy Warmline

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!

Survey Form

* indicates required field

clear* Date of call

*Time of call:

*Peer Supporter Name

1. Was the call free of distractions? (radio, TV, other people)

1 (Poor)

5 (Excellent)

Comments

2. Rate the level of focus and engagement of peer supporter.

1 (Poor)

5 (Excellent)

Comments

3. To what extent did the WARMLINE improve your overall mental health?

1 (Not at all)

5 (Greatly Improved)

Comments

4. Was the call answered in 3 rings?

Yes

Comments

5. Did the peer supporter respect the boundaries on confidentiality?

Yes

Comments

6. Were you allowed to speak without undue interruption?

Yes

Comments

7. Did the peer supporter listen without being judgmental or critical?

Yes

Comments

8. Did the Peer Supporter speak in a warm and friendly manner?

Yes

Comments

9. Did the call end on a positive note?

Yes

Comments

10. Did the Peer Supporter use your name during the call?

Yes

Comments

* 11. Summary of Call and General Impressions

*Your Email Address