LifeLine Ambulance Customer Complaint Form Question Title * 1. What is your name? Question Title * 2. Would you like to be contacted regarding your feedback? Yes No Question Title * 3. What is the best phone number to reach you at? Question Title * 4. What is your email address? Question Title * 5. Which LifeLine location did you work with? Wenatchee Omak Tonasket Oroville Question Title * 6. Date of Incident Date / Time Date Time AM/PM - AM PM Question Title * 7. Location of Incident Question Title * 8. Name(s) of LifeLine personnel (if known) Question Title * 9. Please leave a detailed description of the incident in the space below. Done