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Post Conversation Questionnaire Form

Human Services Division

Care Connections

Thank you for volunteering with the Salem County Care Connections Program! Each time you have completed a conversation with your friend, you are required to complete this form within 48 hours after your phone call has ended. Please fill out the form below and your form will be sent to the Care Connections manager.

Have any questions or need assistance? Please call Jared Cornman at 856-935-7510 ext. 8475 for assistance.

Did your friend seem to be in good spirits and health?(Required)
Was there anything that you believe to be concerning about your friend?(Required)
Did you share the Salem County Office on Aging & Disabilities program information with your friend?(Required)
Did you schedule your next conversation date and time with your participant?(Required)
This field is for validation purposes and should be left unchanged.

Contact Us

Salem County Health Dept.
110 Fifth Street • Suite 500
Salem, NJ 08079

Phone: 856-935-7510
Fax: 856-935-5348

Report An Immediately Reportable Disease: 856-935-7510 x8487
Emergency After Hours: 856-769-1955

Have Concerns?

Report a Public Health Concern

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