Warrington Community Ambulance Corps Medic 129

Survey

Warrington Community Ambulance Corps is committed to provide patients with high quality pre-hospital emergency medical care in a safe and efficient manner. In order to ensure that we are providing a service that meets the needs of the public, we depend on patients to tell us what we are doing right and where improvements can be made. Please fill out the following survey concerning your recent interation with Warrington Community Ambulance Corps. We appreciate your time and thank you for completing our survey.

Date of Call:*

Address or Location of Call:*

Patient's Last Name:*

Please rank the following areas:

Cleanliness of the Ambulance and/or equipment:

Professionalism / appearence of EMS personnel:

EMS personnel's knowledge of your complaint:

Quality of care provided by EMS personnel:

Concern EMS personnel showed for your questions or worries:

Concern EMS personnel showed for the needs of your family and friends:

Degree to which EMS personnel explained the procedures they performed in a manner that you could understand:

Degree to which EMS personnel included you in the treatment decisions (if applicable):

Overall satisfaction with the service you received from Warrington Community Ambulance Corps:

Please offer any additional comments or suggestions:

If any members of our staff were especially helpful, please let us know who they are. We would like to show them our appreciation:

Do you wish to be contacted by Warrington Community Ambulance Corps regarding this survey

Yes

First Name:

Last Name:

Email Address:

Street Address:

Street Address (Line 2):

City:

State:

Zip Code:

Phone Number: