Shippensburg Area EMS Patient Satisfaction Survey
Shippensburg Area EMS is dedicated to providing the highest quality to our customers. Recently, you or a family
member was a patient cared for by our staff. In our ongoing efforts to improve our services to the community we are
asking for you to take a brief moment to complete and submit this survey.
Please use the following rating scale:
5-Extremely Satisfied
4-Moderately Satisfied
3- Neutral
2- Moderately Dissatisfied
1- Extremely Dissatisfied
* Required
Our Staff's Professionalism
*
Extremely Dissatisfied
1
2
3
4
5
Extremely Satisfied
Our Staff's Respect Level Towards You & Your Family Members
*
Extremely Dissatisfied
1
2
3
4
5
Extremely Satisfied
Our Staff's Knowledge Level & Competence Level Towards Your Medical Care
*
Extremely Dissatisfied
1
2
3
4
5
Extremely Satisfied
Our Staff's Ability To Keep You Updated About Your Medical Treatment Plan
*
Extremely Dissatisfied
1
2
3
4
5
Extremely Satisfied
Our Ambulance & Equipment Cleanliness
*
Extremely Dissatisfied
1
2
3
4
5
Extremely Satisfied
Overall Medical Care Received By Our Staff
*
Extremely Dissatisfied
1
2
3
4
5
Extremely Satisfied
Do you feel you received the care you expected from SAEMS?
*
Your answer
What impressed you the most?
*
Your answer
How can we improve our service?
*
Your answer
Any other questions & comments
Your answer
Name & Contact Information (Address, Email, Phone Number) (Optional)
Your answer
Date Of Transport (Optional)
MM
/
DD
/
YYYY
Thank you for taking the time to complete this survey. If you need anything further please contact our EMS Supervisor 24/7 @ 717-532-6069 Ext: 123 or email our Quality Assurance Dept @ qualityassurance@sa-ems.org
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