If you would like to provide feedback about the service you received from a Fort Lauderdale Police Department employee please let us know by filling out the form below. If you do not know the name of the employee; please provide a description.

1

Your Information

 *

Your Information

Name

Date

Street Address

City

State

Zip

ext.Phone Number

Email

2

FLPD Employee Information

FLPD Employee Information

Officer/Employee Name

Badge or ID#

Case# (if applicable)

Employee DescriptionPlease type the employee description if you don't know the employee name or ID#

3

Event Information

Event Information

Date Occurred

Time Occurred

Event Location/Address

Please describe event Event Description

4

Signature - Please type name and date to sign

 *

Signature - Please type name and date to sign

Name

Date

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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