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Nelson County EMS
Compliment / Complaint Form

The following information is being submitted to Nelson County EMS as (select one):

Person Submitting the Information:

Interaction Details:

IF you are filing a complaint, please provide additional information as indicated below:

Convenient time of day for you to be interviewed:

If there were other witnesses to this incident, enter the names and daytime phone numbers of up to five other person(s) that can verify this complaint:

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