Customer Satisfaction Survey

How did you find us?*
- 911
- Stop at Fire Station
- Crew/Fire Truck in Public
- Organized Event
- Other
If Other, please describe how you found us:*
Were you generally pleased with your interaction?*
- Yes
- No
Please Rate the Following Areas of our Service using this scale:
5 - Outstanding Performance 4 - Exceeded Expectations 3 - Met Expectations/Average Performance 2 - Somewhat Dissatisfied 1 - Very Dissatisfied
General Customer Service Overall?*
Timeliness/Speed of Response?*
Appropriate Respect for Dignity, Privacy, and Property?*
Quality of Patient Care?*
Expertise/Knowledge of Staff?*
Professionalism?*
Other Area you'd like to Rate?*
- Yes
- No
Describe Other Area you'd like to Rate:*
Rate Other Area?*

Is there an Individual Member you would like to Recognize or voice a Concern about?*
- Yes
- No
Name of Staff Member:*
Comments about the Staff Member:*
Additional Feedback/Comments:
Please provide any final feedback you'd like to provide.
What can we do better?
Other Comments:
Phone
This field is for validation purposes and should be left unchanged.

Please Rate the Following Areas of our Service using this scale: