Mercy Medical Transportation Customer Survey

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Customer Satisfaction Form

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What date did we transport you to the hospital?

YYYY

What City / Community did we pick you up from?

Was this the first time we transported you?

Yes

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How were our Paramedics?

Use this section to summarize your interaction with our Paramedics.

How would you rate the professionalism of Mercy’s Paramedics?

Poor

Exceptional

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How would you rate the skill of Mercy’s Paramedics?

Poor

Exceptional

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How would you rate the compassion you received from Mercy’s Paramedics?

Poor

Exceptional

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How was our Ambulance?

Use this section to summarize you experience in our Ambulance

How would you rate the appearance of Mercy's Ambulance

Poor

Exceptional

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How would you rate the comfort of your ride in Mercy’s ambulance?

Poor

Exceptional

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How would you rate the skill of the person driving Mercy’s ambulance?

Poor

Exceptional

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Do you feel like Mercy’s ambulance arrived in a timely manner?

Yes

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How was your experience with our Billing Department?

(please skip if you did not need to contact our billing department)

How would you rate the customer service you received from Mercy’s billing staff?

Poor

Exceptional

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Did you receive the help you needed from Mercy’s billing staff?

Yes

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How would you rate your overall experience with Mercy?

Poor

Exceptional

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Please share any additional comments or suggestions:

Please share your name and phone number (if you are available to give us more information to investigate your comments):

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This form was created inside of Mercy Medical Transportation, Inc.