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Patient/Family Survey
*
Indicates required field
Person completing survey?
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Patient
Family
Other
If Other please specify:
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Approximate transport Date
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Flight team introduced themselves.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Flight team were courteous/professional.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Flight team were knowledgeable and skillfull.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I felt safe during the transport.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
N/A
The flight team kept me informed and my questions were answered.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I would recommend this flight service in the future.
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Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Overall rating of your experience with the Med Evac flight team.
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Excellent
Very Good
Good
Ok
Bad
Terrible
Other comments, suggestions on how Med Evac flight team could have better taken care of you or your family.
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Name
*
First
Last
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