Fire Department Customer Service Survey We are sorry to have met you under such difficult circumstances, but we would be grateful to hear your thoughts on the service delivered by our team. Which type of service did you receive from the Fire Department?*Fire ServiceMedical ServiceDate I received service from the Fire Department* Date Format: MM slash DD slash YYYY Service Address* Street Address Address Line 2 City ZIP Code Type of Fire ServiceEmergency ServiceNon-Emergency ServiceWas our team able to help you in your time of need?YesNoPart of our mission is to act in a professional manner. Was our team polite, courteous and attentive to your needs?YesNoIs there anything we can do to improve our service to you and the community?We value any additional comments that you may have to share:Would you like Fire Department Representative to contact you?YesNoIf you'd like to be contacted, please provide your name.* First Last Would you prefer to be contacted by email or telephone?*EmailTelephoneEmail Address* Phone*VFOIA NoticeDo not submit any unsolicited personally identifiable information including (but not limited to) your: (1) social security number; (2) driver's license number; (3) bank account numbers; (4) credit or debit card numbers; (5) personal identification numbers (PIN); (6) electronic identification codes; (7) automated or electronic signatures; or (8) passwords; or (9) any other numbers or information that can be used to access your assets, obtain identification, act as identification, or obtain goods or services. Information submitted through an Arlington County Government website is considered to be a Public Record under the Virginia Public Records Act and may be subject to release by the County in response to a request made under the Virginia Freedom of Information Act.Arlington County may withhold your name and contact information in accordance with the Virginia Freedom of Information Act. Please indicate, by checking the box below, if you would like for the County to seek to keep this information confidential. Please do not disclose my name and contact information in response to a request under the Virginia Freedom of Information Act. I recognize that the County cannot guarantee the confidentiality of my name and contact information but ask that it do so to the extent permitted by law. This information is HIPPA Compliant.NameThis field is for validation purposes and should be left unchanged.
