SUPERSTITION FIRE & MEDICAL DISTRICT

Customer Satisfaction Survey

How was our service?

By completing the following brief survey you can help us achieve our goal of providing excellent service to the SUPERSTITION FIRE & MEDICAL DISTRICT community.

Question Title

* Please identify your relationship with Superstition Fire & Medical District.

RESIDENT

VISITOR

Business OWNER/MANAGER

EMPLOYED within District boundaries

Medical PATIENT

Fire or Rescue VICTIM

Class/Seminar PARTICIPANT

Health Services PARTNER

Public Safety PARTNER

Government Agency PARTNER

Public Education PARTNER

Other (please specify)

Question Title

* Please indicate the reason(s) you had contact with the Superstition Fire & Medical District - Check all that apply.

Medical Response

Vehicle Accident

Rescue

Fire Response

Fire/Smoke Alarm Activation

Hazardous Material Response

Inspection (Business/Construction)

Attended Class or Seminar

Snake Removal

Citizen Assist

Fire & Life Safety Education Services

Question Title

* Please provide the approximate date that you last received services from the Superstition Fire & Medical District.

Enter date of last service

Date