Quality of Care Questionnaire
Please fill out this form to help us evaluate our Volunteer Grief Mentor Program.
Thank you for your valuable participation in making ACCESS the best it can be!
Best way to contact you?
How did you hear about ACCESS?
Your Volunteer Grief Mentor (name):
Was the match appropriate?
Yes, I am happy with my mentor
No, I would like a different mentor to contact me, (please explain):
Was she/he helpful?
Do you have issues/concerns that you were not comfortable discussing with him/her?
(If so, please explain):
Suggestions for improving ACCESS:
To submit this form, please enter the characters you see in the image:
A C C E S S | Toll-Free Helpline: 1-877-227-6435 |