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Beacon Health Transport: Memorial MedFlight Survey 2024
Our promise is to provide the best medical care possible. We thank you in advance for completing the following questions so that we can continue to improve the quality of our services.
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* Indicates required question
Name
*
Your answer
Phone
Your answer
Email Address
Your answer
Preferred Method of Contact
*
Email
Phone
Other:
Flight Number
Your answer
Date of Transport
*
MM
/
DD
/
YYYY
Referring Facility / Agency
*
Your answer
Receiving Facility
*
Your answer
Which of the following best describes your title?
*
Dispatcher
EMS Officer
Fire Officer
Hospital Representative
Nurse
Paramedic
Physician
Police Officer
Other:
Arranging Transport
Please rate your satisfaction with the following aspects of our air medical transport services.
Professionalism of the person you called for transport
*
Very Poor
1
2
3
4
5
Very Good
Overall were you satisfied with the initial call to Memorial MedFlight and/or subsequent dispatch?
*
Very Poor
1
2
3
4
5
Very Good
For Scene Transports ONLY
Radio communications effective for landing zone operations
Very poor
1
2
3
4
5
Very good
Clear selection
Efficiency of the transfer once the team arrived
Very Poor
1
2
3
4
5
Very Good
Clear selection
The team worked well with others caring for the patient.
Very Poor
1
2
3
4
5
Very Good
Clear selection
Did you receive post flight contact from the air medical crew?
Yes
No
Clear selection
Overall Assessment
Ease of working with Beacon Health Transport: Memorial MedFlight
*
Very Poor
1
2
3
4
5
Very Good
Likelihood of recommending our service to others
*
Very Poor
1
2
3
4
5
Very Good
Overall how satisfied were you with your experience
*
Not Satisfied
1
2
3
4
5
Very Satisfied
To thank you for choosing Memorial MedFlight, we would like to send you a free T-Shirt.
BEACON ASSOCIATES -
Your t-shirt will be delivered through interoffice mail. Please fill out your location and department name.
Are you a Beacon associate?
*
Yes
No
If you are a Beacon associate, please select your location.
Beacon Granger Hospital
Community Hospital of Bremen
Elkhart General Hospital
Memorial Hospital of South Bend
Three Rivers Health
Other:
Clear selection
If you are a Beacon associate, please enter your department name.
Your answer
T-Shirt Size
XS
S
M
L
XL
2XL
3XL
Other:
Clear selection
Non-Beacon Associates -
Please enter your address to send t-shirt -
please include city, state and zip code.
Your answer
We'd love to hear from you! Please share your thoughts on what we did well, areas for improvement, and any suggestions, comments, or concerns you may have.
*
Your answer
Thank you for the opportunity to be of service!
If you have any difficulty with this form, contact Blake Mattucci,
Transport Service Outreach & Business Development Coordinator
at
bmattucci@beaconhealthsystem.org
.
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