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2. Patient Satisfaction Survey

6. Thank you for taking the time to fill out this Survey. We are committed to the improvement of patient care in the communities that we serve. This survey is one way for our patients and customers to directly assist us in this work. Thank you!

   Brian Meyers

   Director of Fire & Emergency Services

   Wyoming County Emergency Management

10. Today's Date:
11. Date of Call:
13. Did you receive prompt service?
    -- Select One --YesNo
15. Were you informed of what the Paramedics and EMT's needed to do for your problem?
    -- Select One --YesNo
17. Did the Paramedics and EMT's appear knowledgeable in their treatment of your problem?
    -- Select One --YesNo
19. Were the Paramedics and EMT's courteous in their treatment?
    -- Select One --YesNo
21. Did you have any problems with the care you received?
    -- Select One --YesNo
23. If yes, please comment:
25. Do you remember the names of and Paramedic or EMT's?
    -- Select One --YesNo
27. If you do, who were they:
29. If you want to give any special recognition or make any additional comments about any of the prehospital care providers or the care given, please use the space provided below.
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

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