Patient Satisfaction Survey - MARION COUNTY AMBULANCE DISTRICT

MARION COUNTY AMBULANCE DISTRICT

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Marion County Ambulance Satisfaction Survey

* Indicates required field

Patient Number *

Please enter the patient number located on you bill.

Date of Call *

Please enter the date of call.

Please rate the severity of your pain/problem when the Paramedics first arrived. *

Please rate the severity of your pain/problem when you arrived at the Emergency Room. *

The Paramedic crew acted in a compassionate and caring manner: *

Outstanding Excellent Average Fair Poor

The Paramedic crew presented themselves professionally: *

Outstanding Excellent Average Fair Poor

The Paramedic crew clearly explained the care and procedures they were providing and responded to questions: *

Outstanding Excellent Average Fair Poor

The paramedic crew was thorough in their examination of your problem: *

Outstanding Excellent Average Fair Poor

How well did the crew work together to care for you: *

Outstanding Excellent Average Fair Poor

How would you rate the quality of care provided: *

Outstanding Excellent Average Fair Poor

Was the ambulance ride comfortable and the unit clean: (if not please explain below) *

Outstanding Excellent Average Fair Poor

If you were not completly satisfied with the cleanliness or ride of the ambulance please use the space provided below to explain: *

Do you feel you received great service for your value: *

Outstanding Excellent Average Fair Poor

Please comment on your overall expierience with Marion County Ambulance District: *

Submit

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Home
About
Contact Us
Request an Ambulance For a Event
Education Contact Form
S.T.A.R.S
Training Division
Careers
- Apply Online
News
Links
District Information
Employee Login
Billing
- Patient Satisfaction Survey