Customer Service Survey

How Can we do better?

Whether you are a provider we work with, simply spoke with us on the phone, or we transported you or a loved one in an emergency, please share your experience with us.

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* 1. Date of your experience

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* 2. Please indicate which of the following relationship best describes your interaction with our company Advanced Life Systems Ambulance Service.

Patient

Family Member of A Patient

Hospital Staff

Fire Department Personnel

Caregiver

Other (please specify)

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* 3. Did you or someone else call directly to Advanced Life Systems Ambulance Service to request an ambulance?

Yes

No, myself or someone else dialed 911

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* 4. Please rate your interaction with the Dispatcher that assisted you:

	Excellent	Very Good	Fair	Poor	Very Poor	N/A
Degree of courtesy and politeness by the Dispatcher handling the call intake process	Degree of courtesy and politeness by the Dispatcher handling the call intake process Excellent	Degree of courtesy and politeness by the Dispatcher handling the call intake process Very Good	Degree of courtesy and politeness by the Dispatcher handling the call intake process Fair	Degree of courtesy and politeness by the Dispatcher handling the call intake process Poor	Degree of courtesy and politeness by the Dispatcher handling the call intake process Very Poor	Degree of courtesy and politeness by the Dispatcher handling the call intake process N/A
Efficiency of the dispatcher taking information and answering your questions	Efficiency of the dispatcher taking information and answering your questions Excellent	Efficiency of the dispatcher taking information and answering your questions Very Good	Efficiency of the dispatcher taking information and answering your questions Fair	Efficiency of the dispatcher taking information and answering your questions Poor	Efficiency of the dispatcher taking information and answering your questions Very Poor	Efficiency of the dispatcher taking information and answering your questions N/A
Professionalism of the dispatcher you interacted with.	Professionalism of the dispatcher you interacted with. Excellent	Professionalism of the dispatcher you interacted with. Very Good	Professionalism of the dispatcher you interacted with. Fair	Professionalism of the dispatcher you interacted with. Poor	Professionalism of the dispatcher you interacted with. Very Poor	Professionalism of the dispatcher you interacted with. N/A

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* 5. Help us improve your experience by evaluating the Advanced Life Systems Ambulance and response time:

	Excellent	Very Good	Fair	Poor	Very Poor	N/A
Extent to which the ambulance arrived in a timely manner.	Extent to which the ambulance arrived in a timely manner. Excellent	Extent to which the ambulance arrived in a timely manner. Very Good	Extent to which the ambulance arrived in a timely manner. Fair	Extent to which the ambulance arrived in a timely manner. Poor	Extent to which the ambulance arrived in a timely manner. Very Poor	Extent to which the ambulance arrived in a timely manner. N/A
Comfort of the ambulance ride.	Comfort of the ambulance ride. Excellent	Comfort of the ambulance ride. Very Good	Comfort of the ambulance ride. Fair	Comfort of the ambulance ride. Poor	Comfort of the ambulance ride. Very Poor	Comfort of the ambulance ride. N/A
Cleanliness of the ambulance.	Cleanliness of the ambulance. Excellent	Cleanliness of the ambulance. Very Good	Cleanliness of the ambulance. Fair	Cleanliness of the ambulance. Poor	Cleanliness of the ambulance. Very Poor	Cleanliness of the ambulance. N/A
Skill of the person driving the ambulance.	Skill of the person driving the ambulance. Excellent	Skill of the person driving the ambulance. Very Good	Skill of the person driving the ambulance. Fair	Skill of the person driving the ambulance. Poor	Skill of the person driving the ambulance. Very Poor	Skill of the person driving the ambulance. N/A

Additional Comments

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* 6. Based on your interaction with the ambulance crew providing care please evaluate the following:

	Excellent	Very Good	Fair	Poor	Very Poor	N/A
Degree of professional appearance of the ambulance crew.	Degree of professional appearance of the ambulance crew. Excellent	Degree of professional appearance of the ambulance crew. Very Good	Degree of professional appearance of the ambulance crew. Fair	Degree of professional appearance of the ambulance crew. Poor	Degree of professional appearance of the ambulance crew. Very Poor	Degree of professional appearance of the ambulance crew. N/A
Compassion and care shown by the ambulance crew that transported the patient.	Compassion and care shown by the ambulance crew that transported the patient. Excellent	Compassion and care shown by the ambulance crew that transported the patient. Very Good	Compassion and care shown by the ambulance crew that transported the patient. Fair	Compassion and care shown by the ambulance crew that transported the patient. Poor	Compassion and care shown by the ambulance crew that transported the patient. Very Poor	Compassion and care shown by the ambulance crew that transported the patient. N/A
Extent to which the ambulance crew kept you informed about procedures and actions necessary for your treatment.	Extent to which the ambulance crew kept you informed about procedures and actions necessary for your treatment. Excellent	Extent to which the ambulance crew kept you informed about procedures and actions necessary for your treatment. Very Good	Extent to which the ambulance crew kept you informed about procedures and actions necessary for your treatment. Fair	Extent to which the ambulance crew kept you informed about procedures and actions necessary for your treatment. Poor	Extent to which the ambulance crew kept you informed about procedures and actions necessary for your treatment. Very Poor	Extent to which the ambulance crew kept you informed about procedures and actions necessary for your treatment. N/A
Degree to which the ambulance crew took your emergency seriously.	Degree to which the ambulance crew took your emergency seriously. Excellent	Degree to which the ambulance crew took your emergency seriously. Very Good	Degree to which the ambulance crew took your emergency seriously. Fair	Degree to which the ambulance crew took your emergency seriously. Poor	Degree to which the ambulance crew took your emergency seriously. Very Poor	Degree to which the ambulance crew took your emergency seriously. N/A
Degree to which the ambulance crew listened to you or your family.	Degree to which the ambulance crew listened to you or your family. Excellent	Degree to which the ambulance crew listened to you or your family. Very Good	Degree to which the ambulance crew listened to you or your family. Fair	Degree to which the ambulance crew listened to you or your family. Poor	Degree to which the ambulance crew listened to you or your family. Very Poor	Degree to which the ambulance crew listened to you or your family. N/A
Ambulance crews concern for your privacy.	Ambulance crews concern for your privacy. Excellent	Ambulance crews concern for your privacy. Very Good	Ambulance crews concern for your privacy. Fair	Ambulance crews concern for your privacy. Poor	Ambulance crews concern for your privacy. Very Poor	Ambulance crews concern for your privacy. N/A
Overall, professionalism of the ambulance crew caring for you.	Overall, professionalism of the ambulance crew caring for you. Excellent	Overall, professionalism of the ambulance crew caring for you. Very Good	Overall, professionalism of the ambulance crew caring for you. Fair	Overall, professionalism of the ambulance crew caring for you. Poor	Overall, professionalism of the ambulance crew caring for you. Very Poor	Overall, professionalism of the ambulance crew caring for you. N/A

Additional Comments

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* 7. Please rate your experience with our Billing Department

	Excellent	Very Good	Fair	Poor	Very Poor	N/A
Professionalism of Advanced Life Systems Billing office.	Professionalism of Advanced Life Systems Billing office. Excellent	Professionalism of Advanced Life Systems Billing office. Very Good	Professionalism of Advanced Life Systems Billing office. Fair	Professionalism of Advanced Life Systems Billing office. Poor	Professionalism of Advanced Life Systems Billing office. Very Poor	Professionalism of Advanced Life Systems Billing office. N/A
Billing Specialist's knowledge regarding your billing questions.	Billing Specialist's knowledge regarding your billing questions. Excellent	Billing Specialist's knowledge regarding your billing questions. Very Good	Billing Specialist's knowledge regarding your billing questions. Fair	Billing Specialist's knowledge regarding your billing questions. Poor	Billing Specialist's knowledge regarding your billing questions. Very Poor	Billing Specialist's knowledge regarding your billing questions. N/A
Resolution of your ambulance claim in a timely manner.	Resolution of your ambulance claim in a timely manner. Excellent	Resolution of your ambulance claim in a timely manner. Very Good	Resolution of your ambulance claim in a timely manner. Fair	Resolution of your ambulance claim in a timely manner. Poor	Resolution of your ambulance claim in a timely manner. Very Poor	Resolution of your ambulance claim in a timely manner. N/A
Ability of the Billing Specialist to address your needs and concerns.	Ability of the Billing Specialist to address your needs and concerns. Excellent	Ability of the Billing Specialist to address your needs and concerns. Very Good	Ability of the Billing Specialist to address your needs and concerns. Fair	Ability of the Billing Specialist to address your needs and concerns. Poor	Ability of the Billing Specialist to address your needs and concerns. Very Poor	Ability of the Billing Specialist to address your needs and concerns. N/A
Overall Experience with the Billing Specialist that assisted you.	Overall Experience with the Billing Specialist that assisted you. Excellent	Overall Experience with the Billing Specialist that assisted you. Very Good	Overall Experience with the Billing Specialist that assisted you. Fair	Overall Experience with the Billing Specialist that assisted you. Poor	Overall Experience with the Billing Specialist that assisted you. Very Poor	Overall Experience with the Billing Specialist that assisted you. N/A

Additional Comments

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* 8. How likely are you to recommend Advanced Life Systems, Inc to your friends, family, others?

Very likely

Likely

Neither likely nor unlikely

Unlikely

Very unlikely

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* 9. Overall, how would you rate the company Advanced Life Systems, Inc?

Excellent

Very good

Good

Fair

Poor

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* 10. Please describe any positive or negative experiences with Advanced Life Systems Ambulance.

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* 11. If you would like to be contacted in response to this survey please include your contact information below.

First and Last Name

Call Number or PT Account #

Email Address

Telephone Number