Galax Grayson EMS Cutomer Satisfaction Survey
Exit this survey
1. Default Section
1
. Please enter the trip number as it appears on your bill.
Please enter the trip number as it appears on your bill.
2
. Response time:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Response time:
3
. Crew Appearance:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Crew Appearance:
4
. Crew Interaction With Patient:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Crew Interaction With Patient:
5
. Competency of Crew:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Competency of Crew:
6
. Did the crew act in a courteous/caring manner?
Yes
No
Somewhat
Not Applicable
Did the crew act in a courteous/caring manner?
7
. Did the crew relieve your anxiety/discomfort?
Yes
No
Somewhat
Not Applicable
Did the crew relieve your anxiety/discomfort?
8
. Quality of Care Recieved:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Quality of Care Recieved:
9
. Interaction With Billing Office:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Interaction With Billing Office:
10
. Overall Experience:
Excellent
Very Good
Good
Fair
Poor
Not Applicable
Overall Experience:
Any Additional Comments
Powered by
SurveyMonkey
Create your own
free online survey
now!
Javascript is required for this site to function, please enable.