Client Satisfaction Survey
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Essex-Windsor EMS Patient Satisfaction Survey
How are we doing? For each of the following, please rate your experience.
1.
Appearance of the Paramedics
Excellent
Very Good
Good
Fair
Poor
2.
Politeness, courtesy and professionalism of the Paramedics:
Excellent
Very Good
Good
Fair
Poor
3.
Paramedic interaction with your family and/or friends.
Excellent
Very Good
Good
Fair
Poor
4.
Paramedics expressed a caring and compassionate manner.
Excellent
Very Good
Good
Fair
Poor
5.
Paramedics listened to your concerns.
Excellent
Very Good
Good
Fair
Poor
6.
Paramedics answered all of your questions in an understandable way.
Excellent
Very Good
Good
Fair
Poor
7.
Paramedics explained the care they were providing and why.
Excellent
Very Good
Good
Fair
Poor
8.
Paramedics were respectful of your privacy and home.
Excellent
Very Good
Good
Fair
Poor
9.
Overall experience
Please rate the experience of yourself, your family member or friend.
Excellent
Very Good
Good
Fair
Poor
Other, please specify
10.
Is this form being completed by the patient or by another (family member, close friend, coworker, etc.)?
*
Please answer with 'patient', 'family member', 'close friend', 'coworker', 'other', etc.
11.
Date of call:
*
Please enter the date of the call. If you do not know the date, please enter today's date (yyyy/mm/dd).
Your input is valuable and we thank you for taking the time to complete this evaluation.