Feedback Form
This form is to be used to register feedback related to the service provided by the Winnipeg Fire Paramedic Service.
All information is confidential and will be used for internal purposes only.
Feedback Type
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Thank a WFPS Member
Submit a Concern
First Name
*
Last Name
*
Mailing Address
*
Phone
Email Address
*
Confirm Email Address
*
Patient Name (if different from above)
Invoice Number (If Applicable)
Customer ID (If Applicable)
Relationship to Patient (If Applicable)
Incident Type
*
EMS Call
Fire Response
Fire Inspection
Public Education
Other (Please specify in comments)
Date and Time of Incident
*
Location of Incident
Incident Details/Comments
% = the size of the detail information based on the maximum capacity for this email form. Details may not exceed 100%.
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*
indicates required field.