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Marion County Ambulance Satisfaction Survey
Patient Number
*
Please enter the patient number located on you bill.
Date of Call
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Please enter the date of call.
Please rate the severity of your pain/problem when the Paramedics first arrived.
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Please rate the severity of your pain/problem when you arrived at the Emergency Room.
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0
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The Paramedic crew acted in a compassionate and caring manner:
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Outstanding
Excellent
Average
Fair
Poor
The Paramedic crew presented themselves professionally:
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Outstanding
Excellent
Average
Fair
Poor
The Paramedic crew clearly explained the care and procedures they were providing and responded to questions:
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Outstanding
Excellent
Average
Fair
Poor
The paramedic crew was thorough in their examination of your problem:
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Outstanding
Excellent
Average
Fair
Poor
How well did the crew work together to care for you:
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Outstanding
Excellent
Average
Fair
Poor
How would you rate the quality of care provided:
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Outstanding
Excellent
Average
Fair
Poor
Was the ambulance ride comfortable and the unit clean: (if not please explain below)
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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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