Facility Survey

1. Facility Survey

How are we doing?

United Ambulance Service is committed to providing the highest quality of care to each of our patients. In addition, we are also committed to provide prompt, professional service to each of the facilities that we provide services for. You can help us reach this goal by completing this survey and telling us what you think about our EMS services. All your answers are confidential and you assistance is greatly appreciated.

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* 1. Date of Service:

Date

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* 2. Are our Dispatchers professional and courteous when you arrange for EMS Services?

Yes

Comments

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* 3. Are our EMS Providers usually on time for pickups?

Yes

Comments:

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* 4. Do our EMS Providers demonstrate professionalism?

Yes

Comments:

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* 5. Are our EMS Providers polite and respectful?

Yes

Comments:

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* 6. Are you getting everything you need during the transfer of care?

Yes

Comments:

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* 7. What can EMS do to make things better/easier for you?

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* 8. Additional Comments:

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* 9. Optional:

Facility Name:

Your Name:

Contact #:

If you have any questions or concerns you would like to address immediately, please feel free to call 207.777.6000 and ask to speak with the Supervisor.