Date of Service:      -- mm/dd/yy (required)

1.  Did the ambulance/fire truck arrive promptly?

Yes       No

2.  Did the personnel act/appear professional?

Yes       No

3.  Did the personnel appear caring/concerned about your emergency?

Yes       No

4.  Did the personnel appear knowledgeable/well-trained?

Yes       No

5.  Was the ambulance clean and serviceable?

Yes       No

6.  Please rate your overall experience with the Watauga Fire Department.

Poor
Fair
Average
Good
Excellent

Please provide us with any additional comments:

Please provide the following contact information:
(This section is optional, however, if you provide us with contact information, we will follow-up with you regarding any concerns you may have.)

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Home Phone
E-mail

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