Contact Response Card

Name of person or family contacted:

First and Last Name(s)

Name of person making contact and date of contact:

First and Last Name

Date of Contact

Type of contact:

Select one of the following...

Email

Phone Call

Home Visit

Written

Other

lf you chose other, please share specifics below...

Results of contact:

Select one of the following...

Interested, Plan On Returning

Just Visiting

Did Not Enjoy The Visit

No Response

Additonal Comments Regarding Contact

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