City Council Local Services Feedback Report Form
Share your feedback on local services to help us improve our community.
Your Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number (optional)
Please enter a valid phone number.
Format: (000) 000-0000.
Which local service are you providing feedback on?
*
Please Select
Waste collection
Street cleaning
Parks and recreation
Road maintenance
Public transportation
Water supply
Other
Location of the service (address, intersection, or area)
*
How would you rate your overall satisfaction with this service?
*
1
2
3
4
5
Please rate the following aspects of the service:
*
Rows
Timeliness
Quality
Staff professionalism
Very Dissatisfied
1
2
3
Dissatisfied
4
5
6
Neutral
7
8
9
Satisfied
10
11
12
Very Satisfied
13
14
15
Please describe any issues or concerns you experienced with this service.
Do you have any suggestions for improvement?
Would you like to be contacted for follow-up regarding your feedback?
*
Yes
No
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