1. Default Section

* 1. Date of Service

Date you required a medical response from the South Walton Fire District.

* 2. What is the patient's age?

* 3. The person you called for service (911 Center Dispatcher)

  Excellent Good Fair Poor N/A
Helpfulness of the 911 Dispatcher you called for ambulance services
Concern shown by the 911 Dispatcher
911 instructions were clear and concise until the paramedics arrived

* 4. The Ambulance

  Excellent Good Fair Poor N/A
Ambulance response time
Cleanliness of the ambulance
Comfort of the ambulance ride

* 5. Firefighter/Paramedic personnel

  Excellent Good Fair Poor
Showed genuine concern for my situation
Handled themselves professionally
Displayed professional and neat appearance
Treated me with respect, compassion, and care for my injury/illness
Offered quality, competent care throughout treatment

* 6. Overall Assessment

  Excellent Good Fair Poor
How well did our staff work together to care for you
The provided services were worth the fees charged
Quality of care provided by the SWFD
How would you rate your overall experience with the South Walton Fire District

* 7. Any suggestions to enhance our service?

* 8. May we contact you regarding your comments or concerns