* 1. If you wish to provide the names of the EMT / Parmedic that provided care, please fill out the boxes.

* 2. Date you used Chaffee County EMS

* 3. How professional is our company?

* 4. How would you rate the ambulance crews communication skills ?

* 5. I am satisfied wth the amount of time it took for the ambulance to arrive.

* 6. If I had Pain it was well managed.

* 7. Paying my bill was easy

* 8. Comments:

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