Contact Information (Optional)

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* 1. Contact Information (Optional)

May we contact you for a follow up?

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* 2. May we contact you for a follow up?

What was the date you interacted with Marshfield Fire and Rescue?

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* 3. What was the date you interacted with Marshfield Fire and Rescue?

Date / Time
Were you a patient of Marshfield Fire and Rescue?

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* 4. Were you a patient of Marshfield Fire and Rescue?

If you were a patient, please rate the level of care you received by Marshfield Fire and Rescue staff.

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* 5. If you were a patient, please rate the level of care you received by Marshfield Fire and Rescue staff.

1 (horrible) 5 10 (great)
i We adjusted the number you entered based on the slider’s scale.

T