Date(s) American Ambulance Service was used:

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* 1. Date(s) American Ambulance Service was used:

First Date of Service:
Second Date of Service:
Third Date of Service:
From which city, town, or medical facility did American Ambulance pick you up?

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* 2. From which city, town, or medical facility did American Ambulance pick you up?

Trip Number(s) found on your bill(s), if available:

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* 3. Trip Number(s) found on your bill(s), if available:

If you would like to speak with a Supervisor, please call
In Maine: (207) 703-1152
In Massachusetts: (617) 361-4800
In New Hampshire: (603) 480-5600


PLEASE RATE THE FOLLOWING ASPECTS OF OUR SERVICE:
TIME it took the ambulance to arrive:

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* 4. TIME it took the ambulance to arrive:

Ambulance crew's PROFESSIONALISM:

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* 5. Ambulance crew's PROFESSIONALISM:

Ambulance crew's COMPASSION:

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* 6. Ambulance crew's COMPASSION:

Ambulance crew's KNOWLEDGE:

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* 7. Ambulance crew's KNOWLEDGE:

The MEDICAL CARE you received:

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* 8. The MEDICAL CARE you received:

How well the ambulance crew WORKED TOGETHER:

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* 9. How well the ambulance crew WORKED TOGETHER:

Ambulance crew's APPEARANCE:

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* 10. Ambulance crew's APPEARANCE:

Ambulance's APPEARANCE/CLEANLINESS:

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* 11. Ambulance's APPEARANCE/CLEANLINESS:

COMFORT of the AMBULANCE RIDE:

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* 12. COMFORT of the AMBULANCE RIDE:

HELPFULNESS of the Billing Staff (If Utilized):

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* 13. HELPFULNESS of the Billing Staff (If Utilized):

COURTESY of the Billing Staff (If Utilized):

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* 14. COURTESY of the Billing Staff (If Utilized):

Would you RECOMMEND American Ambulance?

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* 15. Would you RECOMMEND American Ambulance?

Additional Comments:

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* 16. Additional Comments:

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