Patient Survey
Your feedback matters. It helps us provide better care.
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How would you rate the professionalism of our EMS crew?
*
1 – Poor
2 – Fair
3 – Good
4 – Very Good
5 – Excellent
Did our crew treat you with courtesy, dignity, and respect?
*
1 – Poor
2 – Fair
3 – Good
4 – Very Good
5 – Excellent
Did our crew explain your condition and treatment in a way you could understand?
*
1 – Poor
2 – Fair
3 – Good
4 – Very Good
5 – Excellent
How well did our crew listen to your concerns?
*
1 – Poor
2 – Fair
3 – Good
4 – Very Good
5 – Excellent
Did you feel confident in the care you received?
*
1 – Poor
2 – Fair
3 – Good
4 – Very Good
5 – Excellent
Did you feel involved in decisions about your care whenever possible?
*
1 – Poor
2 – Fair
3 – Good
4 – Very Good
5 – Excellent
Was your privacy and modesty respected?
*
1 – Poor
2 – Fair
3 – Good
4 – Very Good
5 – Excellent
How would you rate our response to your emergency?
*
1 – Poor
2 – Fair
3 – Good
4 – Very Good
5 – Excellent
Did our crew make you feel safe during transport?
*
1 – Poor
2 – Fair
3 – Good
4 – Very Good
5 – Excellent
How would you rate the cleanliness and appearance of the ambulance?
*
1 – Poor
2 – Fair
3 – Good
4 – Very Good
5 – Excellent
Did the crew appear to work well together?
*
1 – Poor
2 – Fair
3 – Good
4 – Very Good
5 – Excellent
Did our crew keep you and/or your family informed throughout your care?
*
1 – Poor
2 – Fair
3 – Good
4 – Very Good
5 – Excellent
Would you recommend our EMS service to your family or friends?
*
1 – Poor
2 – Fair
3 – Good
4 – Very Good
5 – Excellent
Overall, how satisfied were you with the care you received from our EMS team?
What did our crew do especially well?
Is there anything we could have done better?
Would you like to recognize a crew member for exceptional service? (Please include their name if known.)
Do you have any additional comments or suggestions?
Unit number (if known)
City of service
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