Anonymous Feedback Form [En Español] Anonymous Feedback Form I would like to give feedback about: * my experience with the Suicide Crisis Line a presentation or training grief support group/services I called the line to: get help for myself get help for someone else get general information or find a resource OtherOther I called the line at the following time/day (optional): The name of the person I spoke with was (optional): This was my first call to the line Yes No Based on my experience, I would call again in the future if needed. Yes No Please tell us about your experience on the Suicide Crisis Line. I am giving feedback about a presentation or training: I attended my child, friend, or client attended This presentation increased my knowledge of suicide warning signs. Yes Somewhat No This presentation increased my ability to get help for myself or someone else. Yes Somewhat No I feel that this presentation was culturally appropriate. Yes Somewhat No I am a: Middle or high school student College student Staff or faculty member at a school Parent Veteran Senior Citizen Therapist/Counselor, Psychiatrist and/or Social Worker Staff member or volunteer at a community organization Other (please explain below) If you answered "Other" above, please explain. The name of the presenter was (optional): The name of my school/agency is (optional): The date/time of the presentation was (optional): I would recommend this presentation to others. Yes No Please explain why you would/would not recommend this presentation to others (optional). Please tell us about the experience at this presentation or training. I am giving feedback about services: I received provided to a friend or family member I am giving feedback about (please check all that apply) Intake process /staff on the administrative line Materials that were sent to me WINGS group - Santa Cruz County LOSS group - Monterey County Therapy or other agency referrals I received from Suicide Prevention Other (please explain below) If you answered "Other" above, please explain. Please tell us about your experience with grief support services provided by our agency. The services provided met my needs and expectations Yes No If the services provided did not meet your needs and expectations, please explain (optional). I would recommend grief support services to others who have lost a loved one to suicide. Yes No If you would not recommend grief services to others, please explain (optional). I would like a staff member to follow up with me about my experience. * Yes No Name Name I would prefer to be contacted in: English Spanish OtherOther I would prefer to be contacted by: Phone Email No preference Phone Number Phone number is: Cell Work Home OK to leave a message on this number? Yes No The best times to reach me by phone are: Email Address Enter Email Confirm Email Address Confirm Email reCAPTCHA Please Note: This form is not intended for crisis or suicide intervention and is not monitored 24 hours a day. 24 hour toll-free Suicide Crisis Line (877) 663-5433 (ONE-LIFE) / (877) Serving Monterey, Santa Cruz, and San Benito Counties for over 50 years
