Post Mediation Survey
Exit Survey
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Please take a moment to answer this brief survey. Your feedback is important to us.
Please indicate Court File Number/Index Number:
Please indicate case type:
Indicate whether you were:
Petitioner/Plaintiff
Respondent/Defendant
What was your role:
Party
Attorney
Support Person
Did you reach an agreement?
Yes
No
If you did not reach an agreement, do you think you made progress?
Yes
No
N/A
If more than one Mediator, was the co-mediation experience positive?
Yes
No
N/A
Please share your opinion about each statement below:
Strongly Disagree
Disagree
No Opinion/ Not Applicable
Agree
Strongly Agree
The Mediator(s) clearly explained how mediation works.
Strongly Disagree
Disagree
No Opinion/ Not Applicable
Agree
Strongly Agree
The Mediator(s) were neutral and fair.
Strongly Disagree
Disagree
No Opinion/ Not Applicable
Agree
Strongly Agree
I was able to explain my point of view and how I felt.
Strongly Disagree
Disagree
No Opinion/ Not Applicable
Agree
Strongly Agree
The Mediator(s) listened to me and understood my concerns.
Strongly Disagree
Disagree
No Opinion/ Not Applicable
Agree
Strongly Agree
The Mediator(s) helped me see the other party's point of view.
Strongly Disagree
Disagree
No Opinion/ Not Applicable
Agree
Strongly Agree
The Mediator(s) helped me understand my own goals, options, or resources.
Strongly Disagree
Disagree
No Opinion/ Not Applicable
Agree
Strongly Agree
I was encouraged to come up with my own solutions.
Strongly Disagree
Disagree
No Opinion/ Not Applicable
Agree
Strongly Agree
I would recommend this Mediator(s) to others
Strongly Disagree
Disagree
No Opinion/ Not Applicable
Agree
Strongly Agree
I would recommend mediation to others.
Strongly Disagree
Disagree
No Opinion/ Not Applicable
Agree
Strongly Agree
Is there anything else you would like to tell us about the Mediator(s) or your experience?
May we contact you within 6 months to follow up?
Yes
No
If yes, please provide your contact Information below:
First Name
Last Name
Phone
Email Address
Date:
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