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2. Please describe the type of service your received*
4. Date of service received (if applicable)
6. Department you received service from*

   1. Animal Control
   2. Arts & Culture
   3. Assessor
   4. Auditor
   5. Building
   6. Central Services
   7. City Clerk
   8. Economic Development
   9. Emergency Dispatch
   10. Fire/Rescue
   11. Health
   12. Human Resources

   1. Information Technology
   2. License Commission
   3. Mayor's Office
   4. Parking
   5. Parks & Recreation
   6. Planning & Sustainability
   7. Police
   8. Public Works
   9. Senior Services
   10. Treasurer/Collector
   11. Veteran's Services
10. Service was provided within the timeframe identified*

    1. Strongly Agree
    2. Agree
    3. Somewhat Agree
    4. Disagree
    5. Strongly Disagree
11. My issue was addressed*

    1. Strongly Agree
    2. Agree
    3. Somewhat Agree
    4. Disagree
    5. Strongly Disagree
13. City staff treated me with respect*

    1. Strongly Agree
    2. Agree
    3. Somewhat Agree
    4. Disagree
    5. Strongly Disagree
14. I am satisfied with the service I received*

    1. Strongly Agree
    2. Agree
    3. Somewhat Agree
    4. Disagree
    5. Strongly Disagree
16. If desired, please enter any additional comments and/or information below regarding the service your received from the City of Northampton
20. Contact Information

    Please complete the below information if you'd like for us to contact you regarding the above information.

22. First Name
23. Last Name
25. What is the best way to contact you? (optional)
    -- Select One --EmailPhoneNo response required
27. Phone Number
28. Email Address
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30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

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