Instructions

This survey asks about your experience with the mediation program. Please select the response that most closely resembles your opinion for each question. Your answers are confidential and will only be used to improve our mediation program.

* 1. How satisfied are you:

  Very satisfied Satisfied Neither Dissatisfied Very dissatisfied
The mediation process was clearly explained to you
The information received prior to mediation was informative and helpful
Our mediator created a safe and respectful environment
Our mediator was genuinely engaged in helping resolve the conflict
Our mediator was neutral and objective
That you had an adequate opportunity to explain your point of view
Mediation helped you understand the other person's perspective
Our mediator helped all parties reach an acceptable outcome
With the mediation process

* 2. Please tell us about the outcome of your mediation

  Yes No Not Sure
Mediation provided a safe environment for you to express your concerns?
Did the other person(s) participate fully in the mediation?
Did mediation help you learn information that will benefit you in the future?
If you have conflict in the future, will you consider resolving it through mediation?
Was mediation an effective way to resolve this issue?
Will you recommend mediation to others?

* 4. Who was your mediator?

* 5. What city or county's mediation program is this?

* 6. When was your mediation held?

Date
/
/

* 7. Name (optional)

* 8. What were the STRENGTHS of the mediation process?

* 9. What were the WEAKNESSES of the mediation process?

* 10. What specific recommendations do you have?

Report a problem

T