Upper Bucks Regional EMS, Inc. Patient Satisfaction Survey

Exit this survey

 

1. WERE YOU THE PATIENT?

WERE YOU THE PATIENT?   YES NO PARENT OR GUARDIAN AUTHORIZED REPRESENTATIVE OTHER

2. WHAT IS YOUR AGE GROUP?

WHAT IS YOUR AGE GROUP?   < 18 18-30 31-50 50-65 65-80 >80

3. WHAT WAS THE LOCATION OF YOUR EMERGENCY?

WHAT WAS THE LOCATION OF YOUR EMERGENCY?   RIEGELSVILLE BOROUGH TINICUM TOWNSHIP NOCKAMIXON TOWNSHIP DURHAM TOWNSHIP BRIDGETON TOWNSHIP SPRINGFIELD TOWNSHIP HAYCOCK TOWNSHIP OTHER

4. WHAT WAS THE TYPE OF EMERGENCY?

WHAT WAS THE TYPE OF EMERGENCY?   MEDICAL/ILLNESS TRAUMA/INJURY OTHER

5. HOW WOULD YOU RATE YOUR RESPONSE TIME OF THE AMBULANCE?

HOW WOULD YOU RATE YOUR RESPONSE TIME OF THE AMBULANCE?   EXCELLENT GOOD ADEQUATE POOR UNACCEPTABLE

6. HOW WOULD YOU RATE THE PROFESSIONALISM OF THE AMBULANCE CREW?

HOW WOULD YOU RATE THE PROFESSIONALISM OF THE AMBULANCE CREW?   EXCELLENT GOOD ADEQUATE POOR UNACCEPTABLE

7. OVERALL, PLEASE RATE THE CLENLINESS OF THE AMBULANCE.

OVERALL, PLEASE RATE THE CLENLINESS OF THE AMBULANCE.   EXCELLENT GOOD ADEQUATE POOR UNACCEPTABLE

8. OVERALL, HOW WOULD YOU RATE THE PERFORMANCE OF THE AMBULANCE CREW?

OVERALL, HOW WOULD YOU RATE THE PERFORMANCE OF THE AMBULANCE CREW?   EXCELLENT GOOD ADEQUATE POOR UNACCEPTABLE

9. BASED ON OUR PERFORMANCE, HOW CONFIDENT ARE YOU IN REQUESTIONG OUR SERVICES AGAIN IN THE FUTURE?

BASED ON OUR PERFORMANCE, HOW CONFIDENT ARE YOU IN REQUESTIONG OUR SERVICES AGAIN IN THE FUTURE?   VERY CONFIDENT CONFIDENT SOMEWHAT CONFIDENT NOT CONFIDENT I WOULD NOT CALL AGAIN