Fire/EMS Engagement Survey

2. We are interested in your opinion about the recent Emergency Medical Services you received from the Village of Midlothian Fire Dept. Please help us to improve our services by answering the questions below.
4. How would you rate the manner in which your call for service was handled by our 911 DISPATCH CENTER?

   1. Excellent
   2. Very Good
   3. Average
   4. Fair
   5. Poor
   6. N/A
6. How would you rate the following of OUR PERSONNEL:

   The level of professionalism exhibited.

   1. Excellent
   2. Very Good
   3. Average

   1. Fair
   2. Poor
7. How would you rate the following of OUR PERSONNEL:

   The level of competence, courtesy, and concern displayed.

   1. Excellent
   2. Very Good
   3. Average

   1. Fair
   2. Poor
9. How would you rate the following of OUR PERSONNEL:

   The explanation of care, questions or services provided.

   1. Excellent
   2. Very Good
   3. Average

   1. Fair
   2. Poor
10. How would you rate the following of OUR PERSONNEL:

    Overall, how would you rate the care you received from us?

    1. Excellent
    2. Very Good
    3. Average

    1. Fair
    2. Poor
12. Please provide us with an explanation if you feel you received service that was less than "average".
14. Is there anything you feel we could improve upon? If so, please explain.
16. Any Additional Suggestions/Comments?
18. First Name*
19. Last Name*
21. Phone Number*
22. Email Address
24. Do you wish to be contacted for additional information?*

    1. Yes

    1. No
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

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