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Customer Satisfaction 2011
Your feedback helps us continue to enhance the service we provide for you and your patients. We appreciate your time in completing this survey.
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1
. Please enter your facility/agency name:
Please enter your facility/agency name:
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2
. Please enter the approximate date of service OR the transport number:
Please enter the approximate date of service OR the transport number:
Date
Transport Number
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3
. Professionalism of the Life Link III Communications Center:
Professionalism of the Life Link III Communications Center:
Excellent
Good
Fair
Poor
n/a
Please identify any applicable issues or concerns
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4
. Professionalism of Life Link III flight crew:
Professionalism of Life Link III flight crew:
Excellent
Good
Fair
Poor
n/a
Please identify any applicable issues or concerns
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5
. Timeliness of aircraft arrival:
Timeliness of aircraft arrival:
Excellent
Good
Fair
Poor
n/a
Please identify any applicable issues or concerns
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6
. Appropriateness of in-hospital or on-scene time:
Appropriateness of in-hospital or on-scene time:
Excellent
Good
Fair
Poor
n/a
Please identify any applicable issues or concerns
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7
. Delivery of clinical care:
Delivery of clinical care:
Excellent
Good
Fair
Poor
n/a
Please identify any applicable issues or concerns
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8
. Follow up call received from Life Link III flight crew:
Follow up call received from Life Link III flight crew:
Yes
No
Unknown
Please identify any applicable issues or concerns
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9
. Life Link III is my first choice when I require air medical transportation:
Life Link III is my first choice when I require air medical transportation:
Always
Usually
Sometimes
Rarely
Never
Please identify any applicable issues or concerns
10
. Additional comments regarding Life Link III's service (optional):
Additional comments regarding Life Link III's service (optional):
11
. Do you wish to be contacted by a Life Link III Outreach Representative?
Do you wish to be contacted by a Life Link III Outreach Representative?
No
Yes (please provide your contact information)
Contact information:
12
. OPTIONAL - Please provide your contact information to be entered in a monthly prize drawing.
OPTIONAL - Please provide your contact information to be entered in a monthly prize drawing.
Name
Phone
Email
Mailing Address
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