CHETA Evaluation Form

 
CHETA - Children's Hospital Emergency Transport Ambulance

Our goal is to provide you with the best transport service possible. We recognize the unique needs of pediatric patients and have developed CHETA in response to your needs. Please help us continue to improve our service by completing the following survey.

If you have any immediate concerns and would like to contact a CHETA Coordinator, please contact us at: smcvicar@uwhealth.org or SLarson4@uwhealth.org.

Please rate the following:

Communications
ExcellentGoodSatisfactoryUnsatisfactoryN/A
Ease of initiating transport
Professionalism of dispatcher
Courtesy of dispatcher
Promptness
Accuracy of quoted arrival time
Informative/supportive physician
Please rate the following:

Transport Team
ExcellentGoodSatisfactoryUnsatisfactoryN/A
Professionalism (Courteous)
Efficiency (Timely)
Proficiency (Clinically competent)
Interactions with patient's family
Please rate the following:

Follow-up
ExcellentGoodSatisfactoryUnsatisfactoryN/A
Timely follow-up provided within 24 hours
Educational (if requested)
Overall experience with CHETA
Please feel free to share any comments or feedback below:
Please complete the following:
Would you like to be contacted by the CHETA Coordinator or Medical Director?
If you have any immediate concerns and would like to contact a CHETA Coordinator, please contact us at: smcvicar@uwhealth.org or SLarson4@uwhealth.org.