Life Lion Customer Service Survey 1

Life Lion Customer Service Survey 1

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1. Default Section

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1. Please enter date and approximate time of transport.

	MM		DD		YYYY		HH		MM	AM/PM
Date/Time	Please enter date and approximate time of transport. Date/Time Month	/	Day	/	Year		Hour	:	Minute	AM or PM

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2. Tell us a little bit about who you are, (Name, phone #, and e-mail are optional).

Tell us a little bit about who you are, (Name, phone #, and e-mail are optional). Name:
Unit/Department/Hospital:
City/Town:
State:
Email Address:
Phone Number:

3. Please pick your provider level/certification/licensure.

	Provider Level
Provider Level	Please pick your provider level/certification/licensure. Provider Level Provider Level

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4. Type of transport:

Type of transport: Scene

Interhospital

Gift of Life

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5. How would you rate the ease of requesting Life Lion?

	Very Poor	Poor	OK	Good	Very Good	N/A
Ease of requesting:	How would you rate the ease of requesting Life Lion? Ease of requesting: Very Poor	Poor	OK	Good	Very Good	N/A

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6. Did we arrive when we predicted?

	Definitely Late	A Little Late	Yes	Early	Really Early
On time?	Did we arrive when we predicted? On time? Definitely Late	A Little Late	Yes	Early	Really Early

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7. Was the appearance of our staff acceptable?

	Not so good	A Little Rough	Average, OK	Better Than Average	Picture Perfect
Appearance:	Was the appearance of our staff acceptable? Appearance: Not so good	A Little Rough	Average, OK	Better Than Average	Picture Perfect

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8. Was the staff courteous?

	Really grumpy.	A Little Grumpy	Yes	Better Than Average	Exceptional
Courteous:	Was the staff courteous? Courteous: Really grumpy.	A Little Grumpy	Yes	Better Than Average	Exceptional

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9. Was our staff knowledgable?

	Need a lot of updating.	Need a little updating.	Yes.	Smarter than the avarage bear.	Exceptional.
Knowledge:	Was our staff knowledgable? Knowledge: Need a lot of updating.	Need a little updating.	Yes.	Smarter than the avarage bear.	Exceptional.

10. Likelihood of recommending us to others.

	Absolutely not.	Maybe not.	Yes.	More than likely.	Absolutely.
Recommendation?	Likelihood of recommending us to others. Recommendation? Absolutely not.	Maybe not.	Yes.	More than likely.	Absolutely.

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