POST-MEDIATION SATISFACTION SURVEY
Please take a few minutes to rate the service you received during the mediation process.
Your confidential response is valuable to us. For each question please circle the number
that reflects your evaluations.
Form completed by:
□ Party filing complaint or □ Party responding to complaint or □ Legal Counsel
1.) I was able to ask questions and say what I needed to say during the mediation.
Not at all 1 2 3 4 5 Completely
2.) Having the mediator present was helpful.
Not at all 1 2 3 4 5 Completely
3.) I have a better understanding of the situation.
Not at all 1 2 3 4 5 Completely
4.) I have a better understanding of the other party’s perspective.
Not at all 1 2 3 4 5 Completely
5.) I believe that other party has a better understanding of my perspective.
Not at all 1 2 3 4 5 Completely
6). The services I received helped me to decide the next steps needed to effectively deal with
the situation.
Not at all 1 2 3 4 5 Completely
7.) I was satisfied with the mediation process.
Not at all 1 2 3 4 5 Completely
8). Overall, the mediation was useful to me.
Not at all 1 2 3 4 5 Completely
9). I would recommend mediation to another person in a similar situation.
Not at all 1 2 3 4 5 Completely
10). I would choose mediation again, if I have another conflict.
Not at all 1 2 3 4 5 Completely
Outcome of mediation (check one), □ agreement □ no agreement □ withdrawal of
complaint.
Additional Comments: ___________________________________________________________