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