Fire Department Feedback Form

2. Your feedback and comments are always welcome. Your contact information is optional; however, please provide if you wish to receive a follow-up call or e-mail.

   Your feedback and comments are always welcome. Your contact information is optional; however, please provide if you wish to receive a follow-up call or e-mail.

4. What contact did you have with the Cosumnes Fire Department?

   1. Ambulance Service

   1. Fire

   1. Other - Please Specify

6. Other Experience

10. Please rate the service you received from Cosumnes Fire Department in the following categories:

12. After the immediate emergency was addressed, Department personnel answered my questions clearly and completely.

    1. Strongly Agree
    2. Agree

    1. Disagree
    2. Strongly Disagree

    1. Not Applicable

14. Cosumnes Fire Department personnel were courteous and helpful.

    1. Strongly Agree
    2. Agree

    1. Disagree
    2. Strongly Disagree

    1. Not Applicable

16. Cosumnes Fire Department personnel provided service in a timely and professional manner.

    1. Strongly Agree
    2. Agree

    1. Disagree
    2. Strongly Disagree

    1. Not Applicable

18. Cosumnes Fire Department appeared knowledgeable about the job that they were performing.

    1. Strongly Agree
    2. Agree

    1. Disagree
    2. Strongly Disagree

    1. Not Applicable

20. I would rate the overall service of the Cosumnes Fire Department as:

    1. Excellent
    2. Very Good

    1. Fair
    2. Poor

    1. Unacceptable
    2. Not Applicable

24. Contact Information
    Optional: Please provide contact information if you wish a follow-up call or email.

    Optional: Please provide contact information if you wish a follow-up call or email.

26. Name

27. Email Address

29. Address

31. City

32. State

33. Zip Code

35. Phone Number

Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field