Marion County Ambulance Satisfaction Survey Patient Number (required) Date of Call (required) Please rate the severity of your pain/problem when the Paramedics first arrived. (required)0 1 2 3 4 5 6 7 8 9 10 Please rate the severity of your pain/problem when you arrived at the Emergency Room. (required)0 1 2 3 4 5 6 7 8 9 10 The Paramedic crew acted in a compassionate and caring manner: (required) Outstanding Excellent Average Fair Poor The Paramedic crew presented themselves professionally: (required) Outstanding Excellent Average Fair Poor The Paramedic crew clearly explained the care and procedures they were providing and responded to questions: (required) Outstanding Excellent Average Fair Poor The paramedic crew was thorough in their examination of your problem: (required) Outstanding Excellent Average Fair Poor How well did the crew work together to care for you: (required) Outstanding Excellent Average Fair Poor How would you rate the quality of care provided: (required) Outstanding Excellent Average Fair Poor Was the ambulance ride comfortable and the unit clean: (if not please explain below) (required) Outstanding Excellent Average Fair Poor If you were not completly satisfied with the cleanliness or ride of the ambulance please use the space provided below to explain: (required) Do you feel you received great service for your value: (required) Outstanding Excellent Average Fair Poor Please comment on your overall expierience with Marion County Ambulance District: (required) There was a problem saving your submission. Please try again later. Please wait while your submission is being saved... Submitting...Submit Thank you, your submission has been received.
