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* 1. Patient was transported by:

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* 2. Type of patient transport:

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* 3. Date and approximate time of transport:

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* 4. How satisfied were you that the patient was treated safely with dignity and compassion?

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* 5. Overall, how satisfied were you with the medical care provided by the transport crew?

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* 6. How satisfied were you with the level of professionalism displayed by the transport crew?

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* 7. How satisfied were you with the professionalism demonstrated by the communications specialist and the communications center?

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* 8. The process of arranging transport for my patient was quick and effortless:

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* 9. Please list any comments or concerns regarding this patient transport:

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* 10. I would like a member of the Life Flight/Mobile Life leadership team to contact me?

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* 11. Please include me in the monthly prize drawing for completed surveys.

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