How did you contact our office?

By written correspondence   In person   By telephone On the internet

If your contact was in person or by telephone:

Were the staff members courteous? YES  NO

Were they knowledgeable and able to answer your questions? YES  NO

What type of service did you request?

Birth Certificate     Death Certificate     Marriage Certificate     Divorce Certificate

Amendment or correction of a record    Statistical  

Did you experience any difficulties in contacting or applying for a vital record?  YES   NO

If YES, please tell us about it in the comments section below.

Did you receive your certificate or other requested material within

the time frame stated when you contacted our office?  YES   NO

Did you request "RUSH" service?  YES   NO

Overall, how would you rate your experience with Vital Statistics?

Excellent   Good   Average   Below average   Poor

If you experience a problem, felt you received exceptionally good service or have a suggestion to improve our service, we would like to know about it.

Please enter the Request number ( labeled as REQ# at the bottom right corner of the certificate received ) if any, along with your comments

in the space provided below:

Tell us how to contact you:

Name
E-mail
Telephone
FAX

Under Florida law, e-mail addresses are public records.

If you do not want your e-mail address released in response to a public-records request,

do not send electronic mail to this agency. Instead contact the office or individual by phone or in writing.

 

Please contact me as soon as possible regarding this matter.