Voice of the Member (VOM)

SixFour3 is a facility designed for YOU, and as such, your voice matters. The form below is intended for you to provide feedback and comments that you think can help improve the overall experience for our members. Please fill out the information below and we will follow up accordingly. 

First & Last Name
First & Last Name
Complaint
If you have any complaints at all, please select from the list below, and/or add to the general comments section below.
Request Supplies
If you see that we are running low on supplies, please select from the options below, and/or add to the general comments section.
Request Equipment
If you see any damaged equipment or low inventory please select from the list below, and/or add to the general comments section. Let us know which lane you noticed this in, in the comments section below.
Out of Order?
Is something not working as it should? If so, select from the list below, and/or add to the general comments section.
Please provide any additional details based on the selections above, or any other general comments, suggestions, or even praise, that you think might be valuable.