SMS DNC™ Registry

Information About You:

Call Recipient:   Telephone number where you received the call/message(s).

( ) -

Date/Time :   When did you receive the call(s)?

Date:  /   /    Time:  :  AM PM

Date:  /   /    Time:  :  AM PM

Date:  /   /    Time:  :  AM PM

Date:  /   /    Time:  :  AM PM

Caller ID Information:  

Did you receive caller ID information for the call(s) in question? Select Yes No Don't have caller ID

Information obtained through caller ID:  ( ) -

Business name:

Did the caller ID information accurately report the name and/or calling number for the call in question?  Select Yes No Not certain

How did you determine it was not accurate? (1000 Characters Max)

Call Information:

Prior Express Consent:

Did you or anyone at your facility give prior express consent for the call(s) to be made?
Select Yes No

Type Of Call(s):

Live (Voice) Call
Prerecorded Message
Text Message
Commercial eMail Message
"Dead Air" or Automated Tones
None of the Above

Describe Call: (1000 Characters Max)

During the call/message;

Was the following information provided?

Name of the business, individual or other entity responsible for the call/message:
Select No Yes

Name(s) provided:

Was this provided at the beginning of the call/message?
Select No Yes

Business telephone number for the entity responsible for the call/message:
Select No Yes

Number(s) provided:

( ) -

( ) -

Other information provided:

Did you listen to the entire call/message?
Select No Yes

Emergency Purpose:

Did the call/message indicate any emergency purpose (a necessary communication in any situation affecting the health and safety of consumers)?
Select Yes No

Describe the Emergency: (1000 Characters Max)

Prerecorded Message - Line Seizure:

Did any message disconnect promptly (within about 5 seconds) after you hung up?
Select Yes No Not certain

Describe: (1000 Characters Max)

Information For The DNC Registry