Skip to content
Check Screen Reader Mode to make this survey compatible with screen readers.
Check Screen Reader Mode to make this survey compatible with screen readers.
Patient Satisfaction Survey - Waynesboro First Aid Crew
*
1.
Date of Transport
(Required.)
Date
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
2.
Name
3.
How would you rate the professionalism / appearance of the crew?
Poor
1 star
Fair
2 stars
Average
3 stars
Excellent
4 stars
Outstanding
5 stars
Comments
4.
How would you rate the cleanliness of the ambulance and/or equipment?
Poor
1 star
Fair
2 stars
Average
3 stars
Excellent
4 stars
Outstanding
5 stars
Comments
5.
Were you treated with courtesy and respect?
Poor
1 star
Fair
2 stars
Average
3 stars
Excellent
4 stars
Outstanding
5 stars
Comments
6.
How well did the provider explain your care and answer your questions?
Poor
1 star
Fair
2 stars
Average
3 stars
Excellent
4 stars
Outstanding
5 stars
Comments
7.
How would you rate your overall experience with the Waynesboro First Aid Crew?
Poor
1 star
Fair
2 stars
Average
3 stars
Excellent
4 stars
Outstanding
5 stars
Comments
Current Progress,
0 of 7 answered
