Quality Assurance Survey

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Quality Assurance Survey

It is our endeavor to provide every patient with the highest standard of professional medical care. Your input is valuable in evaluating our eﬀectiveness and assisting our eﬀorts to improve continually. Please take a moment to ﬁll out this questionnaire.

Name(Required)

First Last

Phone Number

Date of Service(Required)

EMS Call Number(Required)

Overall how satisfied are you with Greenwich EMS?(Required)

Rate Your Care

	Exceptional	Adequate	Inadequate (Please comment)
The EMS crew's eﬀorts to be courteous and helpful were?
The EMS crew's eﬀorts to put the patient and family at ease were?
As a patient, treatment with regard to respect and dignity was?
Did the EMS providers communicate eﬀectively with the patient?
Did the EMS providers communicate eﬀectively with the family?
Keeping in mind that some medical treatments are inherently uncomfortable, was your treatment and transportation to the hospital as comfortable as possible?
Please rate the following with regard to the rendering of medical care: Eﬀiciency
Please rate the following with regard to the rendering of medical care: Compassion
Please rate the following with regard to the rendering of medical care: Professionalism

Comments

Please add any comments that would help us maintain our excellent medical care record.