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Air Transport Survey

Please complete the Air Transport survey below to help us continue to improve our service. Use this scale in determining your response:

1 = Strongly Disagree
2 = Disagree
3 = Neutral
4 = Agree
5 = Strongly Agree
Completed By * 
Completed By (if other selected above) 
Transfer From 
Referring Facility * 
Run Number * 
Rate on a scale of 1 (worst) - 5 (best)
Professional interaction with dispatcher  Worst                                      Best
Timely arrival of mission crew  Worst                                      Best
Satisfactory explanation provided if delay occurred 
Mission crew introduced themselves  Worst                                      Best
Courteous/professional mission crew  Worst                                      Best
Efficient/appropriate preparation of patient for mission  Worst                                      Best
Knowledgeable/skillful mission crew  Worst                                      Best
Rate on a scale of 1 (worst) - 10 (best)
Overall satisfaction 
1=Very Dissatisfied, 10=Very Satisfied
I would recommend this service
for critical care transport in the future.
1 = Would Not Recommend, 10 = Would Highly Recommend
If you have any comments or ideas on
how we can improve our service, then please
enter them in the space provided. We encourage your
participation and value your time and input.
You Contact Information (optional)
Did you have a concern with this transport that
you would like to be contacted about.
* Required
2131 S. 17th Street, Wilmington, NC 28401  |  910.343.7000