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Child Passenger Safety Appointment Satisfaction Survey

  1. Slide 4 FDMJ Main
  2. Please take a moment to complete the survey below
  3. Was CPS Technician that assisted you professional?
  4. Was CPS Technician knowledgeable?
  5. Were you given the opportunity to practice installing the Child Safety Seat(s)?
  6. After instruction and hands on demonstration, how likely do you feel that you can reinstall the Child Safety Seat(s) correctly?
  7. Did CPS Technician discuss any of the following?
    please check all that apply
  8. Was CPS Technician able to answer any questions that you had?
  9. Please rate your overall satisfaction with your appointment.
  10. Thank you from your FDMJ CPS Team
  11. Leave This Blank:

  12. This field is not part of the form submission.