Facility/Scene Provider Survey

FLIGHT DISPATCH 1-800-247-5433

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Facility/Scene Provider Survey

* Indicates required field

Person completing survey? *

Nurse Physician Firefighter EMS Provider Other

If Other please specify: *

Transport Date *

Why did you choose to call Med Evac? *

Response time Patient bedside time Professionalism Confidence in crews skills Courteous/Respectful Patient follow up provided Other (please specify)

Please check all that apply

If other from previous question please specify here: *

Concern was shown to the patient and/or family by the flight team. *

Strongly Agree Agree Neutral Disagree Strongly Disagree

Copetence was demonstrated by the flight team. *

Strongly Agree Agree Neutral Disagree Strongly Disagree

Respect was shown to you and your co-workers by the flight team. *

Strongly Agree Agree Neutral Disagree Strongly Disagree

Flight team worked together to care for the patient. *

Strongly Agree Agree Neutral Disagree Strongly Disagree

Med Evac responded to your needs quickly and efficiently. *

Strongly Agree Agree Neutral Disagree Strongly Disagree

Med Evac transport service was easy to work with. *

Strongly Agree Agree Neutral Disagree Strongly Disagree

Overall rating of Med Evac services. *

Excellent Very Good Good Ok Bad Verby Bad Terrible

Suggestions and/or recommendations of how Med Evac could serve you better. *

If you would like follow up with this survey please fill out below.

Name *

First

Last

Email *

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Med Evac - 1801 16th St. Greeley, CO 80631 - 1-800-247-5433
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