AirLIFE Survey

1. AirLIFE Customer Survey

Thank you for allowing San Antonio AirLIFE to assist you with the care and transport of your patient. Please assist us in improving our services by completing the brief survey below. We appreciate your feedback.
Our success is because of you!

1. When did you utilize AirLIFE's services?

	MM		DD		YYYY
Date:	When did you utilize AirLIFE's services? Date: Month	/	Day	/	Year

2. Was this a scene call or an interfacility transfer?

Was this a scene call or an interfacility transfer? Scene call

Interfacility transfer

3. Mission Number (optional)

Mission Number (optional)

4. Did you get the names of the AirLIFE Crewmembers that assisted you?

Did you get the names of the AirLIFE Crewmembers that assisted you? Names of crew

5. How would you rate our services today?

	Excellent	Above Average	Average	Poor	N/A
Courtesy and efficiency of Flight Coordinator	*How would you rate our services today? Courtesy and efficiency of Flight Coordinator Excellent	Courtesy and efficiency of Flight Coordinator Above Average	Courtesy and efficiency of Flight Coordinator Average	Courtesy and efficiency of Flight Coordinator Poor	Courtesy and efficiency of Flight Coordinator N/A
Accuracy of estimated time of arrival (ETA)	Accuracy of estimated time of arrival (ETA) Excellent	Accuracy of estimated time of arrival (ETA) Above Average	Accuracy of estimated time of arrival (ETA) Average	Accuracy of estimated time of arrival (ETA) Poor	Accuracy of estimated time of arrival (ETA) N/A
Radio communications with aircraft	Radio communications with aircraft Excellent	Radio communications with aircraft Above Average	Radio communications with aircraft Average	Radio communications with aircraft Poor	Radio communications with aircraft N/A
AirLIFE crew treated staff respectfully	AirLIFE crew treated staff respectfully Excellent	AirLIFE crew treated staff respectfully Above Average	AirLIFE crew treated staff respectfully Average	AirLIFE crew treated staff respectfully Poor	AirLIFE crew treated staff respectfully N/A
Appropriate, expeditious care at the scene or facility	Appropriate, expeditious care at the scene or facility Excellent	Appropriate, expeditious care at the scene or facility Above Average	Appropriate, expeditious care at the scene or facility Average	Appropriate, expeditious care at the scene or facility Poor	Appropriate, expeditious care at the scene or facility N/A

6. Why does your agency or facility call AirLIFE?

	Primary consideration	Somewhat of a consideration	Not a consideration
Proximity to my service area	*Why does your agency or facility call AirLIFE? Proximity to my service area Primary consideration	Proximity to my service area Somewhat of a consideration	Proximity to my service area Not a consideration	Proximity to my service area
Rapid response times	Rapid response times Primary consideration	Rapid response times Somewhat of a consideration	Rapid response times Not a consideration	Rapid response times
Speed over ground transport	Speed over ground transport Primary consideration	Speed over ground transport Somewhat of a consideration	Speed over ground transport Not a consideration	Speed over ground transport
Skill level of flight crew	Skill level of flight crew Primary consideration	Skill level of flight crew Somewhat of a consideration	Skill level of flight crew Not a consideration	Skill level of flight crew

7. Overall, was your experience with AirLIFE favorable?

Overall, was your experience with AirLIFE favorable? Yes

If not, please explain reason.

8. Would you like someone from AirLIFE to contact you?

Would you like someone from AirLIFE to contact you? Yes

If yes, please provide your name, agency and contact preference

Check out our sample surveys and create your own now!

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