City of La Porte EMS - Patient Satisfaction Survey

1. Default Section

 
1. Date of Service
MM DD YYYY
Date:
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2. How would you rate the response time of La Porte EMS?
3. How would you rate the appearance of the paramedics?
4. How would you rate the professionalism of the paramedics?
5. How would you rate the paramedics abilities to explain the care and interventions they were providing to you and why?
6. How would you rate the paramedics response to your needs?
7. How would you rate the paramedics interaction with your family and/or friends?
8. How well did the paramedics explain the following forms to you: assignment of benefits form and the HIPPA privacy notice?
9. How confident are you in requesting our services again in the future if need be?
10. How would you rate your overall experience with the City of La Porte EMS?
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