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HEMS Patient Satisfaction Survey

HEMS Patient Satisfaction Survey

Please rate your recent experience with Hamilton EMS. For each statement, please mark the answer that best corresponds to the level of care you received. If a question does not apply, please select N/A. Space is provided at the end of the survey to offer additional questions.
Usefulness of instruction provided by the 911 call operator prior to the arrival of Hamilton EMS personnel. * Required
- Excellent
- Good
- Fair
- Poor
- N/A
Date of service: * Required
MM slash DD slash YYYY
Time of service: * Required

: Hours

Minutes

AM/PM AM/PM
Did the Hamilton EMS personnel introduce themselves? * Required
- Yes
- No
Do you remember the name of the HEMS paramedic that took care of you?
Professionalism and appearance of Hamilton EMS personnel. * Required
- Excellent
- Good
- Fair
- Poor
- N/A
Hamilton EMS personnel's knowledge of your complaint. * Required
- Excellent
- Good
- Fair
- Poor
- N/A
Quality of care provided by Hamilton EMS personnel. * Required
- Excellent
- Good
- Fair
- Poor
- N/A
Care that Hamilton EMS personnel showed for your questions or worries. * Required
- Excellent
- Good
- Fair
- Poor
- N/A
Concern Hamilton EMS personnel showed for the needs of your family/friends. * Required
- Excellent
- Good
- Fair
- Poor
- N/A
Degree to which Hamilton EMS personnel explained the procedures they performed in a manner that you could understand. * Required
- Excellent
- Good
- Fair
- Poor
- N/A
Cleanliness of Hamilton EMS ambulance and equipment. * Required
- Excellent
- Good
- Fair
- Poor
- N/A
Overall satisfaction with the service you received from Hamilton EMS. * Required
- Excellent
- Good
- Fair
- Poor
- N/A
Please offer any additional comments or suggestions in the space provided.
If any members of our staff were especially helpful, please let us know who they are. We would like to show them our appreciation.
Contact Information
(optional)
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HEMS

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Emergency Medical Services (EMS)
HEMS Patient Satisfaction Survey

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Vitruvian Health
PO Box 1900
Dalton, GA 30722-1900
[email protected]
706.272.6000

Hamilton Medical Center
1200 Memorial Drive
Dalton, GA 30720
706.272.6000
706.272.6001 (TTY)

Bradley Medical Center
2305 Chambliss Avenue NW
Cleveland, TN 37311
423.559.6000

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