Plum EMS Patient Satisfaction Survey

Thank you for taking the time to complete the Plum EMS Patient Satisfaction Survey.  We value your input and are extremely interested in learning more about your experience with Plum EMS.  The Patient Satisfaction Survey should take approximately five minutes to complete.  Space is provided at the end of the survey if you would like to include your contact information. 

Contact Information (Optional)

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* 1. Contact Information (Optional)

Date of Incident

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* 2. Date of Incident

Date
Courtesy of the 911 Call Taker

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* 3. Courtesy of the 911 Call Taker

Professionalism / Appearance of Plum EMS personnel.

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* 4. Professionalism / Appearance of Plum EMS personnel.

Quality of care provided by Plum EMS personnel.

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* 5. Quality of care provided by Plum EMS personnel.

Level of concern Plum EMS showed for your questions or worries.

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* 6. Level of concern Plum EMS showed for your questions or worries.

Level of concern Plum EMS personnel showed for the needs of your family and friends.

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* 7. Level of concern Plum EMS personnel showed for the needs of your family and friends.

Degree to which Plum EMS personnel explained the procedures they performed in a manner that you could understand

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* 8. Degree to which Plum EMS personnel explained the procedures they performed in a manner that you could understand

Cleanliness of ambulance and equipment

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* 9. Cleanliness of ambulance and equipment

Overall satisfaction with the service you received from Plum EMS.

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* 10. Overall satisfaction with the service you received from Plum EMS.

Please offer any additional comments or suggestions in the space provided.

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* 11. Please offer any additional comments or suggestions in the space provided.

If any of our team members were especially helpful, please let us know who they are.  We would like to show them our appreciation.

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* 12. If any of our team members were especially helpful, please let us know who they are.  We would like to show them our appreciation.

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