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:

Scale:
1 = Strongly Disagree
2 = Disagree
3 = Neutral
4 = Agree
5 = Strongly Agree

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

Scale:
1 = Strongly Disagree
2 = Disagree
3 = Neutral
4 = Agree
5 = Strongly Agree

Completed By
*
Transfer From
*
*
Rate on a scale of 1 (worst) - 5 (best)
Professional interaction with dispatcher
Timely arrival of mission crew
Satisfactory explanation provided if delay occured
Mission crew introduced themselves
Courteous/professional mission crew
Efficient/appropriate preparation of patient for mission
Knowledgeable/skillful mission crew
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
Comments
Your Contact Information (optional)
Did you have concerns with this transport that you would like to be contacted about?