Patient Satisfaction Survey

We value your input and are extremely interested in learning more about your recent experience with AAFD EMS. The Patient Satisfaction Survey should take approximately five minutes to complete. If you would like to include your contact information, space is provided at the end of the survey.

For each statement, check the circle that corresponds to the level of care you received from AAFD EMS. If a question does not apply, please select N/A. Space is provided at the end of the survey to offer additional comments.

911 Experience

Courtesy of the 911 call operator
Usefulness of instruction provided by the 911 call operator prior to the arrival of AAFD EMS personnel

EMS Experience

Professionalism and appearance of AAFD EMS personnel
AAFD EMS personnel's knowledge of your complaint
Quality of care provided by AAFD EMS personnel
Concern AAFD EMS personnel showed for your questions or worries.
Concern AAFD EMS personnel showed for the needs of your family and friends
Degree to which AAFD EMS personnel explained the procedures they performed in a manner that you could understand
Cleanliness of the ambulance and equipment
Overall satisfaction with the service you received from AAFD EMS

Additional Comments

Contact Information

This information is optional
Would you like to be contacted by AAFD EMS regarding this survey?