2. Date of Service or Program*
   Date of Service or Program
3. Location of the Incident or Program*
5. Select the type of service provided to you by the Port Arthur Fire Department:*

   1. Emergency Medical Service
   2. Fire Suppression
   3. Public Assistance
   4. Fire Safety Training

   1. Fire Inspection
   2. Life Safety Community Education
   3. Community Event
   4. Other (Please list below)
7. Other service not listed above:
9. Did personnel arrive in a timely manner?*

   1. Yes
   2. No
   3. Maybe
10. Were firefighters professional in their actions?*

    1. Higher than expected
    2. Met expectations
    3. Lower than expected
12. Were firefighters courteous and respectful during all interactions?*

    1. Strongly Agree
    2. Agree
    3. Neutral
    4. Disagree
    5. Strongly Disagree
13. Please indicate the statement that best reflects your attitude toward the quality of service you received from the Port Arthur Fire Department:*

    1. Higher than expected
    2. Met expectations
    3. Lower than expected
15. Please share any additional thoughts on your experience with the firefighters of the Port Arthur Fire Department:
17. Would you like the Port Arthur Fire Department to contact you to discuss your experience?

    1. Yes, contact me.
    2. No, do not contact me.
19. If yes, please provide your contact information:
21. First Name
22. Last Name
24. Phone Number
25. Email Address
Leave This Blank:


27. Submit

* indicates a required field