EMERALD ISLE EMS customer satisfaction survey

This survey is completely anonymous. However, if you would like further information on services, please enter your personal information at the bottom of this survey and someone from the department will contact you.

Question Title

1. How would you rate the overall quality of the service you received?

Question Title

2. Please rate the quality of the medical care you received.

Question Title

3. Please rate the caring/compassion of our staff

  excellent Very Good Good Poor Very Poor
Care/Compassion

Question Title

4. Is there anything that you feel we could improve on?

Question Title

5. Is there anything in your daily routine that you could use help with? i.e. - medication organization,  home safety, etc.

Question Title

6. Do you need any assistance/training on your own medical devices? i.e.- blood glucose monitor, blood pressure monitor, etc.

Question Title

7. How long have you been a resident of Emerald Isle?

  6 months to 1 year 1 - 3 years 4 or more years
Length of time

Question Title

8. What is your age group?

  18 - 29 30 - 59 60 - 79 80+
Age group

Question Title

9. Do you have any other comments, questions, or concerns?

Question Title

10. Please include only if you would like further information

T