The Forest Park Fire Department

Your relation to the patient:

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* 1. Your relation to the patient:

Patient's age:

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* 2. Patient's age:

Did you experience or witness the care given by paramedics?

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* 3. Did you experience or witness the care given by paramedics?

If you experienced or witnessed the care given by paramedics, please evaluate the following:

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* 4. If you experienced or witnessed the care given by paramedics, please evaluate the following:

  Excellent Good Fair Poor Not Sure
Paramedics' concern for you/patient
Paramedics' ability to listen to you/patient
Paramedics' information about your/patient's care options
Paramedics' concern for your/patent's privacy
Degree to which the paramedics listened to you and/or your family
Paremedics' professionalism

T