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What was the date of service?

What was the reason for the visit?

Fire Emergency
Medical Emergency
Vehicle Accident
Hazardous Materials
Inspection
Public Service
Public Education

Did you call 911?

Yes
No
No, somebody called for me

How would you rate your overall satisfaction with the 9-1-1 operator?

Very Satisfied
Somewhat Satisfied
Neutral
Somewhat Dissatisfied
Very Dissatifed

How long do you feel it took emergency services to arrive at the scene of your emergency?

Please state what your exact emergency call was for?

After your emergency was under control, did someone give you information as to what was going on?

Were there any services that you believe should have been performed, that were not offered?

Would you like someone from the South Santa Clara County Fire District to contact you?