1. Default Section

* 1. Date of Service

Date:
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* 2. How would you rate the response time of La Porte EMS?

* 3. How would you rate the appearance of the paramedics?

* 4. How would you rate the professionalism of the paramedics?

* 5. How would you rate the paramedics abilities to explain the care and interventions they were providing to you and why?

* 6. How would you rate the paramedics response to your needs?

* 7. How would you rate the paramedics interaction with your family and/or friends?

* 8. How well did the paramedics explain the following forms to you: assignment of benefits form and the HIPPA privacy notice?

* 9. How confident are you in requesting our services again in the future if need be?

* 10. How would you rate your overall experience with the City of La Porte EMS?

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