COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : Index No. Calendar No. MEDIATION SATISFACTION QUESTIONNAIRE Plaintiff(s) -against- : JUDICIAL SUBPOENA : The purpose of this questionnaire is to obtain information to help us improve the quality of mediation serves we provide. Your answers to the following questions : would be very helpful to us. All answers are confidential. ****************************************************************************** : (To be filled out by the mediators) Defendant(s) : ...................................................... LENGTH OF MEDIATION SESSION: DATE: MEDIATOR (S): THE PEOPLE OF THE STATE OF NEW YORK TYPE OF CASE: TO ****************************************************************************** QUESTIONNAIRE INSTRUCTIONS This questionnaire includes yes/no questions and answer lines*. For each answer line GREETINGS: should place a mark on the line where you feel it best represents your opinion. question, you You can mark anywhere on the line. For example, if you have a positive opinion about the WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before question but believe there is room for improvement, you could answer the question as illustrated , the Honorable at the Court below. located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed orNegative/disagreetestify and give evidence as aNeutral in this action on the part of the Positive/agree adjourned date, to witness Please answer every question and include your comments. Thank you for taking the time to complete this questionnaire. Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalfyour subpoena was issued for a maximum penalty of $50 and all damages sustained as a Please return this completed questionnaire to the court clerk before leaving. result of your failure to comply. 1. or a defendant ? A. Are you a plaintiff Witness, were your B. WhatHonorable initial thoughts about mediation? Court in County, day of , one of the Justices of the , 20 Comments: (Attorney must sign above and type name below) 2. How would you rate your first impression of the mediators handling your case? Attorney(s) for Unfavorable 3. Neutral Favorable How would you rate the comfort and appropriateness of the physical setting arranged by the mediators for your session? Office and P.O. Address Uncomfortable Mediation Satisfaction Questionnaire - 1 Neutral Comfortable Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: SC4-9 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : : 4. Calendar No. How clear were the introductory remarks and explanation of the mediation process : offered by the mediators? JUDICIAL SUBPOENA Plaintiff(s) Unclear 5. Index No. -against- Neutral : Clear : How comfortable were you during the mediation session? Uncomfortable Neutral : Comfortable Defendant(s) : ...................................................... 6. How would you rate your overall satisfaction with the manner in which the mediators conducted the mediation session? Dissatisfied THE PEOPLE OF THE STATE OF NEW YORKNeutral 7. TO Satisfied How involved were you in the problem-solving process? Not Involved Neutral Involved GREETINGS:the mediators give both parties an equal chance to explain their case? 8. Did WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Yes No , the Honorable at the Court located at County of inComments: room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the 9. How fair were the mediators to both sides? Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a Unfair Neutral Fair result of your failure to comply. 10. If you had co-mediators assisting you, how well did the two mediators work together Witness, Honorable , one of the Justices of the during the mediation process? Court in County, day of Not Well 11. , 20 Neutral Well Did the mediation process address the main issues(Attorney must sign above and type name below) of your dispute? Yes No Attorney(s) for Comments: Office and P.O. Address 12. Did the mediation end successfully (i.e., with a mutually agreeable solution)? Mediation Satisfaction Questionnaire - 2 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: SC4-9 American LegalNet, Inc. www.USCourtForms.com COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : Index No. : Yes Comments: : No Plaintiff(s) -against- Calendar No. JUDICIAL SUBPOENA : : : 13. If you reached an agreement, were the terms and conditions of the agreement clear to Defendant(s) you? : ...................................................... Unclear Neutral Clear 14. How well was the tone set for YORK THE PEOPLE OF THE STATE OF NEW future problem solving with the other party? TO Negative Tone 15. Neutral Positive Tone Did you have enough time for the mediation? GREETINGS: Yes No If no, how much more time was needed? WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , at the Court located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the Comments: the Honorable 16. How satisfied were you with the overall mediation? Unsatisfied Neutral Satisfied Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whosewilling thisutilize mediation in the future? 17. Are you behalf to subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. No Yes Witness, Honorable Court in County, Comments: day of , one of the Justices of the , 20 (Attorney must sign above and type name below) 18. Do you have any other comments or suggestions? Attorney(s) for Office and P.O. Address *Answer line developed by Dr. Jack E. Vincent for U.N. research purposes. Mediation Satisfaction Questionnaire - 3 Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: SC4-9 American LegalNet, Inc. www.USCourtForms.com