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2. Report as:*
   -- Select One --AnonymousAs Myself
3. To be contacted about an interaction, please select "As Myself" from the dropdown and we will ask for your name and a contact number. If you do not wish to provide contact information you can select "Anonymous" from the dropdown.
7. First Name
8. Last Name
10. Contact Number
11. Contact Email
13. Rate Your Interaction*

    Select how you felt your interaction was with the County employee

    1. Terrible

    1. Okay

    1. Good

    1. Great
15. Time of Interaction
    -- Select One --During Business Hours (M-F)After Business Hours (M-F)During the Weekend
16. Location of Interaction
    -- Select One --Receiving Service in a County BuildingOutside of a County BuildingIn Public (After Hours/Weekend)Other
18. Description of Interaction*
    Please provide a detailed description of your interaction with the County employee. List the employees name and/or department if you have that information
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20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit

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