Citizen Feedback Form

Thank you in advance for your feedback. We value the stories and input of each of our citizens. Please be as detailed as possible and we will do our best to take action to implement your feedback.

Please be as detailed as possible.

Which City department would you like leave feedback on?

Which methods did you use to contact our city offices? (please check all that apply)

Phone

Fax

In Person

Through Website

Name of employee/s that assisted you?

Employee 1

Employee 2 (if applicable)

Please select the boxes that most accurately represent your experience:

Please select the boxes that most accurately represent your experience:
	Very Satisfied	Somewhat Satisfied	Neutral	Somewhat Dissatisfied	Very Dissatisfied
Friendliness of Staff	Friendliness of Staff/Very Satisfied	Friendliness of Staff/Somewhat Satisfied	Friendliness of Staff/Neutral	Friendliness of Staff/Somewhat Dissatisfied	Friendliness of Staff/Very Dissatisfied
Knowledge of Staff	Knowledge of Staff/Very Satisfied	Knowledge of Staff/Somewhat Satisfied	Knowledge of Staff/Neutral	Knowledge of Staff/Somewhat Dissatisfied	Knowledge of Staff/Very Dissatisfied
Speed of Service	Speed of Service/Very Satisfied	Speed of Service/Somewhat Satisfied	Speed of Service/Neutral	Speed of Service/Somewhat Dissatisfied	Speed of Service/Very Dissatisfied
Quality of Service	Quality of Service/Very Satisfied	Quality of Service/Somewhat Satisfied	Quality of Service/Neutral	Quality of Service/Somewhat Dissatisfied	Quality of Service/Very Dissatisfied

Please describe your experience:

How can we make this experience better? If not applicable, enter NA.

Thank you for your feedback! Please supply your contact information so we may follow-up with you. Thanks again!

Phone Number (not required)