Fishers Fire Department EMS Patient Satisfaction Survey

General Information

We want to thank you in advance for completing our survey. Your response will help us in improving our service to the citizens that we serve

Question Title

Date of Service

On what Date did you require Fishers EMS response

Date

Question Title

Is Patient

Male

Female

Non-Binary

Prefer not to Answer

Question Title

What is patient's age?

Under 18

18 to 30

31 to 44

45 to 54

55 to 64

65 to 70

71-80

81+

Prefer to not answer

INSTRUCTIONS: Please rate the services you received while using our ambulance service. Click on the dot that best describes your experience. If a question does not apply to you or is unknown, please mark N/A. Space is provided for you to comment on positive or negative experiences that may have happened to you.

Question Title

The person you called for service (911 Call Taker)

	Poor	Fair	Good	Very Good	N/A
Helpfulness of the 911 Call Taker when you called for EMS	Helpfulness of the 911 Call Taker when you called for EMS Poor	Helpfulness of the 911 Call Taker when you called for EMS Fair	Helpfulness of the 911 Call Taker when you called for EMS Good	Helpfulness of the 911 Call Taker when you called for EMS Very Good	Helpfulness of the 911 Call Taker when you called for EMS N/A
Concern shown by the Call Taker	Concern shown by the Call Taker Poor	Concern shown by the Call Taker Fair	Concern shown by the Call Taker Good	Concern shown by the Call Taker Very Good	Concern shown by the Call Taker N/A
Extent to which you were told what to do until the ambulance arrived	Extent to which you were told what to do until the ambulance arrived Poor	Extent to which you were told what to do until the ambulance arrived Fair	Extent to which you were told what to do until the ambulance arrived Good	Extent to which you were told what to do until the ambulance arrived Very Good	Extent to which you were told what to do until the ambulance arrived N/A

Comments (describe positive or negative experiences):

Question Title

* Date of Service

Question Title

* Is Patient

Question Title

* What is patient's age?

Question Title

* The person you called for service (911 Call Taker)

Date of Service

Is Patient

What is patient's age?

The person you called for service (911 Call Taker)