2. Thank you for participating in the Clay Fire Territory Car Seat Installation program. Please take a few moments to give us some feedback to make your experiences with us better.
4. Date and Time of Car Seat Installation?*
   Date and Time of Car Seat Installation?

   Date and Time of Car Seat Installation?
6. Name of Car Seat Technician?*
   Found in lower left corner of card
8. How easy was it to schedule your car seat installation appoinment?*

   1. Very easy
   2. Somewhat easy
   3. Somewhat difficult
   4. Very difficult
10. If your answer above was anything other than "Very easy" please explain:
12. How satisfied were you overall with your car seat installation?*

    1. Very satisfied
    2. Somewhat satisfied
    3. Somewhat dissatisfied
    4. Very dissatisfied
14. If your answer above was anything other than "Very satisfied" please explain:
16. Please rate the professionalism of your car seat technician.*

    1. Excellent
    2. Good
    3. Fair
    4. Poor
18. Comments:
20. How well did your car seat technician explain the process of installing the car seat?*

    1. Excellent
    2. Good
    3. Fair
    4. Poor
22. Comments:
24. How well did your car seat technician answer any questions you had?*

    1. Excellent
    2. Good
    3. Fair
    4. Poor
26. Comments:
28. How knowledgeable was your car seat technician?*

    1. Very knowledgeable
    2. Somewhat knowledgeable
    3. Somewhat unknowledgeable
    4. Very unknowledgeable
30. If your answer above was anything other than "Very knowledgeable" please explain:
32. How likely are you to refer a friend or family member to Clay Fire Territory for a car seat installation?*

    1. Very Likely
    2. Somewhat likely
    3. Somewhat unlikely
    4. Very unlikely
34. If your answer above was anything other than "Very likely" please explain:
36. Any additional comments or concerns:
38. Thank you for your participation in the Clay Fire Territory Car Seat Installation program. If you would like to be contacted to discuss your car seat installation with one of our staff members, please enter your name, phone number, and email below. One of our staff members will contact you at their earliest convenience to discuss your appointment.
40. Name
41. Email address
43. Phone Number
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45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

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