Brevard County Customer Service Feedback Form

Express your concerns or appreciation to us.

In accordance with Board of County Commissioners direction, anonymous complaints cannot be accepted in Districts 3, 4 or 5. Therefore, anonymous complaints received for these districts will not be investigated.

Subject	Required
Department / Office Serviced By	Required
Organizational Unit	Optional
County Park Name	Optional
Your Full Name	Optional
Your Address	Optional
	Contact me with the result by phone or email.
Your Phone Number	-- Optional
Your Email Address	Optional
Date Serviced	Required
Who assisted you?	Optional
What type of service was provided?	Required
How long did you wait for service?	Required

Rate Our Employees	Excellent	Good	Fair	Poor	Very Bad
	Hover over the stars and select a rating based on the legend above.
Courteous Attitude	Optional
Responsiveness	Optional
Helpfulness	Optional
OVERALL RATING OF SERVICE	Optional

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