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1. Date of Feedback? (Required.)

Date

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2. What was the date and time of the event? (Required.)

Date
Time

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3. What is your name?
(If anonymous, please write, "Anonymous") (Required.)

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4. What is the best way to contact you?  What telephone number, home address or email address would you like to use? (Required.)

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5. What department would you like to provide feedback on?

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6. What service were you seeking? (Required.)

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7. Was the Team Member assisting you (check the boxes that apply)...

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8. What did the County do well?

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9. How could the County have served you better?

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10. How would you like to see this feedback resolved?

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11. What other information would you like to share? (Required.)

T