The Chair Conversations™ — Codman Square Pilot — The Insightful Way™
Complete after every session. This is your outcome data, your referral record, and your proof of concept for funders.
ConfidentialRecord every connection made — organization, type of support, how they were connected.
Referral 1
Referral 2
Referral 3
Referral 4
Referral 5
Document every direct human-to-human transfer. Note whether accompaniment followed.
Handoff 1
Handoff 2
Handoff 3
What came up organically — 2 to 3 key themes the room raised on its own.
People who may need individual outreach after the session.
Anything else worth capturing — what worked, what didn't, what to do differently, what needs follow-up.
This form is designed for print. Use Print Form to save a PDF or send to a printer after each session.