Please do not forget to fill out your feedback form immediately after meeting with your referral. Answer all questions as fully as possible, your responses will not be shared with your referral. Remember, feedback is vital for the overall success of your program and is required before receiving additional referrals.
Your Information...
*
required fields
*
Full Name: (First
and Last)
*
E-mail address:
*
Age:
*
Contact Phone:
(
) -
About Your Referral...
*
required fields
*
Introduction's Name:
Was a contact made?
Yes
No
If not, why?
Was a date made?
Yes
No
If not, why?
*
Good or compatible qualities:
*
Poor or incompatible qualities:
Will you be meeting again?
Yes
No
Unsure
Please send my next referral?
Yes
No
Please place my membership on HOLD
Yes
No
Reason to Hold Membership:
Comments, Questions, Suggestions!:
Please give us additional comments about your Introduction...
Was your introduction fun?
No Comment
Yes
Average
No
Did you find your introduction interesting?
No Comment
Yes
Average
No
Was your introduction polite?
No Comment
Yes
Average
No
Was your introduction prompt?
No Comment
Yes
Average
No
Did you find your introduction attractive?
No Comment
Yes
Average
No
Was your introduction dressed appropriately?
No Comment
Yes
Average
No
Was this a "good" introduction overall?
No Comment
Yes
Average
No
© 2008 Heart to Heart Introductions