Tele Verification Survey
Please complete this form to document the outcome and details of your telephonic verification call.
Full Name of the Person Contacted
*
First Name
Last Name
Phone Number Contacted
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date and Time of Verification Call
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Verification Outcome
*
Successfully Verified
Unsuccessful - No Answer
Unsuccessful - Wrong Number
Follow-up Needed
Other
Reason for Outcome (if unsuccessful or follow-up needed)
Additional Comments or Feedback
Submit Survey
Should be Empty: