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^* Did we arrive in a timely manner? -- Yes No N/A

^* Did we present a clean and professional appearance? -- Yes No N/A

^* Did we conduct ourselves in a courteous and respectful manner? -- Yes No N/A

^* Did we solve your problem/meet your need to your satisfaction? -- Yes No N/A

Please offer any additional comments or suggestions in the space provided below:

^* What type of interaction did you have with LFR staff? -- Emergency Medical Fire Non-Emergency Assistance Public Education/Speaking Event Station Tour Business Inspection Preplan Activity Other

If other, please explain:

^* Date of experience/observation (mm/dd/yy):

^* General location/specific address of experience/observation:

^* Your name:

Would you like a representative from LFR Administration to contact you over this experience/observation? If so, please provide a phone number (include area code):

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