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2. Name
3. Email Address
4. Phone Number
6. Address
8. City
9. State
10. Zip Code
12. Name of Deputy
14. Type of Contact*

    1. Property Crime
    2. Person Crime

    1. Disturbance
    2. Traffic Stop

    1. Other
16. Your Role*

    1. Victim
    2. Reporting Party

    1. Witness
    2. Concerned Person

    1. Other
    2. Not Applicable
18. Incident Date & Time
    Incident Date & Time

    Incident Date & Time
20. Please Rate the Following (if Applicable)
22. Response Time

    1. Excellent

    1. Satisfactory

    1. Needs Improvement

    1. Unsatisfactory
24. Was Deputy Courteous & Professional?

    1. Excellent

    1. Satisfactory

    1. Needs Improvement

    1. Unsatisfactory
26. Were You Treated with Respect & Consideration?

    1. Excellent

    1. Satisfactory

    1. Needs Improvement

    1. Unsatisfactory
28. Did Deputy Show Concern for Your Situation?

    1. Excellent

    1. Satisfactory

    1. Needs Improvement

    1. Unsatisfactory
30. Deputy Listened to What I Had to Say.

    1. Excellent

    1. Satisfactory

    1. Needs Improvement

    1. Unsatisfactory
32. Was the Deputy Knowledgeable?

    1. Excellent

    1. Satisfactory

    1. Needs Improvement

    1. Unsatisfactory
34. Deputy's Ability to Resolve Your Situation.

    1. Excellent

    1. Satisfactory

    1. Needs Improvement

    1. Unsatisfactory
36. Deputy Took Time to Explain Their Actions &/or Offered Alternatives.

    1. Excellent

    1. Satisfactory

    1. Needs Improvement

    1. Unsatisfactory
38. Rate the Overall Service Provided by the Deputy.

    1. Excellent

    1. Satisfactory

    1. Needs Improvement

    1. Unsatisfactory
40. Please Feel Free You Provide Any Additional Comments or Concerns.
42. Would You like Return Contact?*

    1. No

    1. Yes, by Telephone

    1. Yes, by Email

    If yes, please be sure to include your contact information at the top of this form.

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44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field