New Windsor EMS Customer Satisfaction Survey
The Town of New Windsor EMS is committed to providing outstanding service to its residents. In order to help us evaluate if we are providing the level of service our community wants, we ask you to evaluate your recent contact with us by completing this brief survey. Your answers will be kept confidential and we want to thank you for taking the time to complete this survey.
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Patient Number *
Date of Call *
MM
/
DD
/
YYYY
Please rate the severity of your pain/problem when the Paramedics first arrived. *
No Pain
Severe Pain
Please rate the severity of your pain/problem when you arrived at the Emergency Room. *
No Pain
Severe Pain
Please evaluate the performance of the Paramedic crew: *
Outstanding
Excellent
Average
Fair
Poor
The Paramedic crew acted in a compassionate and caring manner:
The Paramedic crew presented themselves professionally:
The Paramedic crew clearly explained the care and procedures they were providing and responded to questions:
The Paramedic crew was thorough in their examination of your problem:
How well did the crew work together to care for you?
How would you rate the quality of care provided?
Was the ambulance ride comfortable and the unit clean: (if not please explain below) *
If you were not completely satisfied with the cleanliness or ride of the ambulance, please use the space provided below to explain:  
Do you feel you received great service for your value? *
Please comment on your overall experience with New Windsor Ambulance: *
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