Quality Assurance Survey
It is our endeavor to provide every patient with the highest standard of professional medical care. Your input is valuable in evaluating our effectiveness and assisting our efforts to improve continually. Please take a moment to fill out this questionnaire.
Name
Overall how satisfied are you with Greenwich EMS?
Very SatisfiedSomewhat SatisfiedNeither Satisfied or DissatisfiedSomewhat DissatisfiedVery Dissatisfied
Very Satisfied
Somewhat Satisfied
Neither Satisfied or Dissatisfied
Somewhat Dissatisfied
Very Dissatisfied
Rate Your Care
ExceptionalAdequateInadequate (Please comment)
The EMS crew's efforts to be courteous and helpful were?
Exceptional
Adequate
Inadequate (Please comment)
The EMS crew's efforts to put the patient and family at ease were?
Exceptional
Adequate
Inadequate (Please comment)
As a patient, treatment with regard to respect and dignity was?
Exceptional
Adequate
Inadequate (Please comment)
Did the EMS providers communicate effectively with the patient?
Exceptional
Adequate
Inadequate (Please comment)
Did the EMS providers communicate effectively with the patient?
Exceptional
Adequate
Inadequate (Please comment)
Keeping in mind that some medical treatments are inherently uncomfortable, was your treatment and transportation to the hospital as comfortable as possible?
Exceptional
Adequate
Inadequate (Please comment)
Please rate the following with regard to the rendering of medical care: Efficiency
Exceptional
Adequate
Inadequate (Please comment)
Please rate the following with regard to the rendering of medical care: Compassion
Exceptional
Adequate
Inadequate (Please comment)
Please rate the following with regard to the rendering of medical care: Professionalism
Exceptional
Adequate
Inadequate (Please comment)