West Michigan Air Care Feedback
Thank you for utilizing West Michigan Air Care (Air Care) for your patient transport! Please let us know any feedback or comments you have so we can improve our service. All questions are optional.
Please do NOT provide HIPPA sensitive, patient specific information over this form.
Please provide the following flight information:
Date of Flight:
MM
/
DD
/
YYYY
Agency or Hospital Requesting Air Care
Your answer
General location of the patient - Hospital Department if in Hospital or Township/City if a scene.
Your answer
Your role in the patient care (optional)
Requesting Transport
Please rate the Air Care Communication Specialist the answered the phone in the following questions.
If you did not speak with them, you may leave this section blank.
How professional was the Air Care Communication Specialist?:
Poor
Excellent
How well were you kept aware of the status and ETA of the transport team?:
Poor
Excellent
How satisfied were you with the overall process of requesting Air Care?:
Poor
Excellent
How well did the Metro Alert app work for you during this request? (Leave blank if not used)
Poor
Excellent
Any additional feedback related to requesting Air Care or the Communication team:
Your answer
Patient Care
Please rate the Medical Crew (Flight Nurses) on the following areas with
1 being low or poor and 5 being high or excellent.
How Professional was the Medical Crew?:
Poor
Excellent
How well did the Medical Crew communicate with the medical team, patient and family?:
Poor
Excellent
How well did the Medical Crew listen to your report and information?:
Poor
Excellent
Any additional feedback related to the Medical team or patient care:
Your answer
What is your overall impression of Air Care?
Would you recommend Air Care to others?
Would you like us to speak to someone directly about this transport? (optional)
If you would like to be entered into a drawing for Air Care materials please provide your information below: (Optional)
Name and Address
Your answer
Phone or Email (required if you wish for followup related to this feedback)
Your answer
Any additional comments or feedback:
Your answer
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