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Facility/Scene Provider Survey
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Person completing survey?
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Nurse
Physician
Firefighter
EMS Provider
Other
If Other please specify:
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Transport Date
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Why did you choose to call Med Evac?
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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:
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Concern was shown to the patient and/or family by the flight team.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Copetence was demonstrated by the flight team.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Respect was shown to you and your co-workers by the flight team.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Flight team worked together to care for the patient.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Med Evac responded to your needs quickly and efficiently.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Med Evac transport service was easy to work with.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Overall rating of Med Evac services.
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Excellent
Very Good
Good
Ok
Bad
Verby Bad
Terrible
Suggestions and/or recommendations of how Med Evac could serve you better.
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If you would like follow up with this survey please fill out below.
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