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Customer Survey

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Steps

1. Your Demographic Information This section is complete This section is incomplete
2. Your Feedback This section is complete This section is incomplete
3. Comments & Additional Information This section is complete This section is incomplete

Your Demographic Information

Your Survey ID Number (If Applicable)
Community That the Call Originated In
Other
Please fill in the corresponding community if not listed
Station That Responded (If Known)
Your Age Range
Type of Service Received
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Your Feedback

Please follow any unsatisfactory marks with a brief explanation below:
My expectations of the RFD, prior to this interaction, where:
1. High
2. Normal or Average
3. Low
Comments
My 911 call was answered promptly:
1. Strongly Agree
2. Agree
3. No Opinion / Neutral
1. Disagree
2. Strongly Disagree
3. Not Applicable
Comments
The 911 Operator(s) handled my call in a professional and courteous manner:
1. Strongly Agree
2. Agree
3. No Opinion / Neutral
1. Disagree
2. Strongly Disagree
3. Not Applicable
Comments
The response time of the Fire / EMS units met my expectations:
1. Strongly Agree
2. Agree
3. No Opinion / Neutral
1. Disagree
2. Strongly Disagree
3. Not Applicable
Comments
The general appearance of Rogers firefighters / paramedics met my expectations:
1. Strongly Agree
2. Agree
3. No Opinion / Neutral
1. Disagree
2. Strongly Disagree
3. Not Applicable
Comments
The knowledge and/or service provided by the Rogers firefighters / paramedics met my expectations:
1. Strongly Agree
2. Agree
3. No Opinion / Neutral
1. Disagree
2. Strongly Disagree
3. Not Applicable
Comments
The firefighters / paramedics provided explanations regarding the treatment and/or procedures being performed:
1. Strongly Agree
2. Agree
3. No Opinion / Neutral
1. Disagree
2. Strongly Disagree
3. Not Applicable
The department members were courteous and respectful:
1. Strongly Agree
2. Agree
3. No Opinion / Neutral
1. Disagree
2. Strongly Disagree
3. Not Applicable
Comments
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Comments & Additional Information

Comments
Please list any improvements, suggestions, concerns, or positive feedback. Include the names of personnel involved if possible.
Additional Information
Please follow up on any negative remarks with additional information. Include the names of personnel involved if possible.
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Last Name
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Rogers, AR 72756
Phone: 479-621-1117

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