MSERT Feedback Form
MSERT strives to provide the best possible experience for patients and bystanders who interact with our responders. We value feedback and suggestions from those who have utilized our service, as this continuously improves our quality of care.

All feedback submitted through this form is anonymous and confidential. Written feedback will be used for internal purposes only; numerical and situational responses may be used externally only in aggregate. This information helps us revise and improve our training protocols as well as providing honest assessments of the efficacy of our service.

Please note that none of the fields are mandatory.
In what capacity did you interact with MSERT?
How did you hear about MSERT?
What was the location of the interaction?
What injuries or medical emergencies were covered during this call?
Please evaluate your overall experience with MSERT.
Is there anything you would change about the care received?
Your answer
Please evaluate the professionalism of the responder(s) you interacted with.
Very bad
Very good
Please evaluate the communication between responder(s) and patient(s).
poor communication that harmed treatment
communication was clear, concise, and effective
Were any of the communication problems due to accessibility constraints, including but not limited to disabilities or linguistic/cultural barriers?
Did you have any concerns related to our handling of sensitive matters, including but not limited to gender and sexual orientation, sexual violence, or mental health?
If you answered "yes" to either of the last two questions, please explain.
Your answer
Please evaluate the demeanor of the responder(s) you interacted with. (If you interacted with more than one responder for this particular incident, use an average.)
Responders were unkind, mean, or harsh and failed to display compassion for the patient(s).
Responders were kind, friendly, amiable, and displayed compassion for the patient(s).
If the responder(s) recommended additional resources at the end of the call, how likely are you to use those resources?
Would you request MSERT in the future?
Please explain your answer to the last question.
Your answer
Any additional feedback, comments, or suggestions?
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy