Hotline Feedback
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1. Introduction
Thank you for choosing to participate in this survey. Participation is voluntary, anonymous, and confidential. We appreciate that you have taken the time to help us improve the quality of our services.
1
. On what date did you access our 24-hour hotline?
MM
DD
YYYY
Date
On what date did you access our 24-hour hotline? Date Month
/
Day
/
Year
2
. How quickly did the on-call advocate return your call?
How quickly did the on-call advocate return your call?
Within 5 minutes
Within 10 minutes
Within 15 minutes
Within 30 minutes
Over 30 minutes
3
. Upon returning your initial call, was the advocate courteous and professional?
Upon returning your initial call, was the advocate courteous and professional?
Yes
No
N/A
4
. Did the advocate help identify a support system with you?
Did the advocate help identify a support system with you?
Yes
No
N/A
5
. Did the advocate discuss your next steps/plan of action following this hotline call?
Did the advocate discuss your next steps/plan of action following this hotline call?
Yes
No
N/A
6
. If appropriate, were you provided with a list of referrals?
If appropriate, were you provided with a list of referrals?
Yes
No
N/A
7
. What were you looking for when initially making the call to the 24-hour hotline? (Please check all that apply.)
What were you looking for when initially making the call to the 24-hour hotline? (Please check all that apply.)
Support
Information
Referral
Counseling Request
Outreach
Other (please specify)
8
. What is your gender?
What is your gender?
Female
Male
Prefer not to answer
9
. What is your age?
What is your age?
10
. Please feel free to add any additional comments you would like the staff to consider.
Please feel free to add any additional comments you would like the staff to consider.
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