Hillsdale Volunteer Ambulance Service - Patient Care Survey
Thank you for coming here to fill out our patient care survey for your time with our ambulance crew. Please answer the questions below to help give us feedback about our crews and patient care. We are HVAS is a 100% volunteer agency and we provide 911 response to Hillsdale and surrounding towns in the Pascack Valley when requested via mutual aid.

In 2018, HVAS answered 876 emergency calls, a growing number in the past few years, and we have never billed a single patient. The average bill for non-volunteer EMS transports is more than $1,000 and we hope after responding to our survey that you consider making a contribution to our corps via the secure link. We thank you in advance for your support of our agency and hope we don’t have to meet by “accident” again anytime soon!

Please select your rating for each of the following questions below:
Date of Service (if known)
MM
/
DD
/
YYYY
Call Number (if known, can be found on bottom of letter received)
Your answer
Ambulance response time to my incident
Professionalism and appearance of HVAS personnel
Quality of care received by HVAS personnel
Respect received from HVAS personnel
Cleanliness of ambulance and equipment used
Overall satisfaction with services received
Please use this space for additional comments or clarifications of your ratings above.
Your answer
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service