Marshfield Fire and Rescue
Customer Service Survey

Question Title

* 1. Contact Information (Optional)

Name

Email Address

Phone Number

Question Title

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

Yes

No

Question Title

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

Date / Time

Date

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

Yes

No

Question Title

* 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)

Clear

i We adjusted the number you entered based on the slider’s scale.