Patient Experience Feedback Question Title * 1. Did our crew members introduce themselves? Yes No Question Title * 2. Was our ambulance on time? Yes (within 30 minutes) No (over 30 minutes) Question Title * 3. Did the ambulance appear clean and in good repair? Yes No Did not notice or do not recall Question Title * 4. Did you feel safe throughout the transport? Felt very safe Felt safe Felt slightly safe Felt unsafe Question Title * 5. Were you / your Patient comfortable during the transport? Very comfortable Comfortable Not very comfortable Question Title * 6. Did you feel your needs and feelings were taken into account during the journey? At all times Only some of the time Not at all Question Title * 7. Did you observe the crew washing their hands or using hand gel during your tiem with them? Only once Several times Do not observe or do not recall Question Title * 8. Were you kept informed during the journey? Yes No Do not recall Question Title * 9. Did the crew seek your consent to transport and/or provide treatment? Yes No Do not recall Question Title * 10. How would you rate your overall experience of our service? Excellent Very good Good Average Poor Would you like to make any additional comments: Done