How did we treat you?
This form is completely optional, all information that you provide will help us improve our service to better serve you.

1 is below expectations
3 is met expectations
5 is exceeded expectations

Date of Call for help
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DD
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Time of Day you called for help
Our personal perform their jobs quickly, efficiently and professionally
Below Expectations
Exceeded Expectations
Our personal explained procedures before they were performed
Below Expectations
Exceeded Expectations
Our personal took special consideration for you and your belongings
Below Expectations
Exceeded Expectations
Our personal took personal responsibility to answer your questions
Below Expectations
Exceeded Expectations
Our personal helped you without being asked and anticipated your needs
Below Expectations
Exceeded Expectations
How was your services with the 911 Dispatch center
Below Expectations
Exceeded Expectations
Did you receive prompt ambulance response time
Below Expectations
Exceeded Expectations
How was the transportation to the medical facility?
Below Expectations
Exceeded Expectations
How was your Overall Care
Below Expectations
Exceeded Expectations
What was the single most important action taken by the crew?
Your answer
What should we have done differently?
Your answer
What was your outcome/diagnosis? (Optional)
Your answer
Any Additional Comments?
Your answer
Would you like to be contacted by one of out department officers
If yes, please list your name the best way of contacting you
Your answer
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