Email 1. Assumed Gender of Caller* Female Male Undetermined 2. Assumed Age of Caller* 18-23 24-30 31-40 41-50 51-60 61-70 71-80 Above 80 3. Caller's Reason for Call* Not Specific Relationship Health Job Money Other: 4. Lifestage of Caller* Newlywed Widow Empty Nester Higher Education Business Owner New Parent Caregiver Single Divorced Other 5. Was the caller complete at the end of the call?*From 1 to 10: least to mostPlease enter a number from 1 to 10.6. Caller's emotion on the call:* Grief Anger Happiness Fear Loneliness Happiness Bewilderment Confusion Other Select all that apply7. Did you hold your Container through the call?* 1-Closed Circuit Sovereign 2 3 4 5 6 7 8 9 10 - Emotional Sponge Sticky 8. Length of the Call - # minutes*9. Caller Location* 10. Was the call a success?* 1- Least 2 3 4 5 - Most Notes - Anything else of note:*
