Beacon Health System Transport Survey 2019
Email address *
Our promise is to provide high-quality care to meet the needs of women, infants, and children throughout our region. We thank you in advance for completing the following questions so that we can continue to improve the quality of our services.
Date of Transport
MM
/
DD
/
YYYY
Transport Number:
Your answer
Referring Facility / Department
Your answer
Which best describes your title: *
Type of Transport *
Mode of Transport
Arranging Transport
Please rate your satisfaction
Courtesy and professionalism with the initial phone contact regarding transport
Very Poor
Very Good
Promptness in responding to your needs / request for transport
Very Poor
Very Good
The amount of time it took to speak with the accepting provider was appropriate
Very Poor
Very Good
Additional comments on arranging transport:
Your answer
Communication with Patient & Family
Transport team greeted and introduced themselves to family / staff upon arrival
Very Poor
Very Good
Team interacted with patient in a supportive and professional manner
Very Poor
Very Good
Team interacted with family in a supportive and professional manner
Very Poor
Very Good
Additional comments on communication with patient and family upon arrival:
Your answer
Transport Team
Knowledge of team
Very Poor
Very Good
Respect and courtesy shown to you / your staff
Very Poor
Very Good
How well the team worked with others who cared for this patient
Very Poor
Very Good
Additional comments on the transport team:
Your answer
Overall Assessment
Ease of working with our organization
Very Poor
Very Good
Likelihood of recommending our services to others
Very Poor
Very Good
Overall rating of our services
Very Poor
Very Good
Would you be interested in receiving educational offerings from Beacon Health System?
Telephone Number for follow up
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service