SBES Patient Survey Page 1

How Did We Treat You?

Please do NOT place and personal identifying information in the fields below

What is the 8 digit letter number above your address on the letter you were mailed? *

... performed their jobs quickly, efficiently and professionally? *

... explained procedures before it was performed *

... took special consideration for you and your belongings *

... took personal responsibility to answer your questions *

... helped you without being asked and anticipated your needs *

How well were you provided with quality service in these areas?

9-1-1 Dispatcher *

Prompt Ambulance Response Time *

Coordination between Fire, Police and Ambulance services *

Transportation to / from Medical Facility *

Overall Pre-Hospital Care *

What was the single most important action taken by the crew? *

What should have been done differently? *

What was your outcome/diagnosis? (Optional) *

Additional Comments: *

Optional: Name *

First

Last

Optional: Email *

Optional: Phone Number *

Optional: *

Please have an officer contact me regarding my above answers