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2. How did we do?
4. First Name*
5. Last Name*
7. Email*
8. Phone Number
10. Date and Time of Visit*
    Date and Time of Visit

    Date and Time of Visit
12. What Department or Division did you visit, communicate with or try to contact?*
14. Name of city employee you talked to or tried to contact?
16. Were you helped promptly?*

    1. Yes
    2. No
18. Were staff knowledgeable and professional*

    1. Yes
    2. No
20. Please rate your satisfaction with the service you received, 5 being excellent and 1 being poor.*
    -- Select One --5 - Excellent4 - Above Avergae3 - Average2 - Below Average1 - Poor
22. How can we do better?
24. Would you like the City to follow up with you regarding your visit?*

    1. Yes
    2. No
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26. Submit

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