Southern Oklahoma Ambulance Service

At Southern Oklahoma Ambulance Service, we strive to provide the very best and most professional care possible. Your feedback is very important to us. The information you provide about your experience will allow us to continually improve our services. Thank You!

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* 1. Which of our services did you utilize?

Emergency Ambulance from home, business or other facility

Emergency Ambulance from an accident scene

Ambulance transfer from hospital to hospital

Ambulance transfer from hospital to home or other facility

Public Event Stand By

Private Event Stand By

I did not personally use your service

Other (please specify)

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* 2. When was your service provided?

Date of Service

Date

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* 3. (Optional) If you have received a bill or other correspondence from us, please provide the patient account number:

Account Number:

Incident Number:

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* 4. (All fields are Optional) Please provide the following information:

Your Name:

Patient Name:

Address:

City/Town:

State:

Email Address:

Phone Number:

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* 5. Overall, how satisfied or dissatisfied are you with our company?

Very satisfied

Somewhat satisfied

Neither satisfied nor dissatisfied

Somewhat dissatisfied

Very dissatisfied

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* 6. Which of the following words would you use to describe our service? Select all that apply.

Reliable

High quality

Useful

Unique

Impractical

Ineffective

Poor quality

Unreliable

Comments

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* 7. Keep in mind that we provide both emergency and non-emergency services. Based on your specific need, how appropriate was our response?

Extremely appropriate

Very appropriate

Somewhat appropriate

Not so appropriate

Not at all appropriate

Comments

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* 8. How would you rate the professionalism of our medics?

Very high professionalism

High professionalism

Neither high nor low professionalism

Low professionalism

Very low professionalism

Comments

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* 1. Which of our services did you utilize?

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* 2. When was your service provided?

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* 3. (Optional) If you have received a bill or other correspondence from us, please provide the patient account number:

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* 4. (All fields are Optional) Please provide the following information:

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* 5. Overall, how satisfied or dissatisfied are you with our company?

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* 6. Which of the following words would you use to describe our service? Select all that apply.

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* 7. Keep in mind that we provide both emergency and non-emergency services. Based on your specific need, how appropriate was our response?

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* 8. How would you rate the professionalism of our medics?

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