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Name:*
Address:
E-Mail Address:*
E-Mail addresses are confidential and are never redistributed.
Type of call:*
Ex. Chest Pain, Car Accident, Fire
Phone Number:
Date of call:*
Can we contact you to follow up on this call?
Please tell us how our Firefighters/Paramedics performed by answering the following questions:
They provided quality medical care:
They displayed a "we want to help attitude":
They were courteous:
They performed their jobs quickly and efficiently:
They explained all care and procedures given:
The quality of service exceeded my expectations:
How satisfied are you with the quality of service in these areas?
Reciept of 9-1-1 call:
Response time:
Medical Treatment:
Ambulance Transportation:
Any additional comments and suggestions are appreciated below: