* 1. Contact Information (Optional)

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

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

Date / Time
/
/

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

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

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

T