Piedmont Rescue Patient Satisfaction Survey

The staff at Piedmont Rescue is committed to providing excellent emergency medical services to all of our patients. By taking a moment of your time to answer the following questions, you will assist us in improving the quality of care and services we provide.

How would you rate the response time of Piedmont Rescue?

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* 1. How would you rate the response time of Piedmont Rescue?

How would you rate the appearance and professionalism of the crew?

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* 2. How would you rate the appearance and professionalism of the crew?

How would you rate the paramedics ability to explain the care and interventions they were providing?

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* 3. How would you rate the paramedics ability to explain the care and interventions they were providing?

How would you rate the crews response to your needs?

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* 4. How would you rate the crews response to your needs?

How would you rate the crews interaction with your family and/or friends?

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* 5. How would you rate the crews interaction with your family and/or friends?

How would you rate the possibility of requesting our services again in the future?

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* 6. How would you rate the possibility of requesting our services again in the future?

How would you rate your overall expierence with Piedmont Rescue?

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* 7. How would you rate your overall expierence with Piedmont Rescue?

Explanations and/or additional comments:

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* 8. Explanations and/or additional comments:

Date of Service:

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* 9. Date of Service:

Patient Name: (optional)

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* 10. Patient Name: (optional)

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