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2. Are you a resident of the City of Mesquite?*

   1. Yes
   2. No
4. How did you make contact with the Mesquite Fire Department?*

   (Choose the option below that most closely relates to your comments about the Department.)

   1. I was an EMS patient (treated by paramedics/used the ambulance).
   2. I used fire suppression services (called for help due to a fire).
   3. I own or manage a business in Mesquite.
   4. I would like to thank a crew/station for their help.
   5. I am not happy with the service I received from the Mesquite Fire Department.
   6. I have a general question or concern.
6. Do you recall the date you made contact with us?
   Do you recall the date you made contact with us?
8. Please tell us more about your experience with the Department.
10. Would you like to be contacted by a Member of the Mesquite Fire Department?

    1. Yes
    2. No

    If so, please complete the contact information section below.
12. First Name
13. Last Name
15. Email address
17. Phone Number
    Please include your area code.
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19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field