SATISFACTION SURVEY

• Who is taking the survey?
  PatientFamily MemberHealthcare Professional

• If American Ambulance Service Inc., recently treated and transported you please answer these questions. Your feedback will assist us in continuously improving the quality of care and services we provide.
• Date of Service*
  MM slash DD slash YYYY
• 1. The American Ambulance team member(s) introduced themselves and the organization they were from.
  • Agree
  • Neutral
  • Disagree
• 2. The American Ambulance team member(s) were polite and respectful.
  • Agree
  • Neutral
  • Disagree
• 3. The American Ambulance team member(s) had a professional appearance.
  • Agree
  • Neutral
  • Disagree
• 4. The American Ambulance team member(s) told me or a family member what they were doing and listened to me.
  • Agree
  • Neutral
  • Disagree
• 5. The overall quality of care I received from American Ambulance was excellent.
  • Agree
  • Neutral
  • Disagree
• 6. My experience with American Ambulance exceeded my expectations.
  • Agree
  • Neutral
  • Disagree
• 7. Would you utilize the services of American Ambulance again if needed in the future?
  • Agree
  • Neutral
  • Disagree
• 8. If any member of our team especially stood out, please let us know who they are? We would like to show them our appreciation.
• 10. Additional Comments
• 11. Contact me about my experience.*
  • Yes! Please have an American Ambulance team member contact me to discuss my experience
  • No, please do not contact me.
• Name*
  First Last
• Preferred Method of Contact*
  • Phone
  • Email
• Phone*
• Email*
• Date of Service*
  MM slash DD slash YYYY

• If American Ambulance Service Inc., recently treated and transported a family member please answer these questions. Your feedback will assist us in continuously improving the quality of care and services we provide.
• Date of Service*
  MM slash DD slash YYYY
• 1. The American Ambulance team member(s) introduced themselves and the organization they were from.
  • Agree
  • Neutral
  • Disagree
• 2. The American Ambulance team member(s) were polite and respectful.
  • Agree
  • Neutral
  • Disagree
• 3. The American Ambulance team member(s) had a professional appearance.
  • Agree
  • Neutral
  • Disagree
• 4. The American Ambulance team member(s) told me or a family member what they were doing and listened to me.
  • Agree
  • Neutral
  • Disagree
• 5. The overall quality of care I received from American Ambulance was excellent.
  • Agree
  • Neutral
  • Disagree
• 6. My experience with American Ambulance exceeded my expectations.
  • Agree
  • Neutral
  • Disagree
• 7. Would you utilize the services of American Ambulance again if needed in the future?
  • Agree
  • Neutral
  • Disagree
• 8. If any member of our team especially stood out, please let us know who they are. We would like to show them our appreciation.
• 9. Additional Comments
• 10. Contact me about my experience.
  • Yes! Please have an American Ambulance team member contact me to discuss my experience
  • No, please do not contact me.
• Name*
  First Last
• Preferred Method of Contact*
  • Phone
  • Email
• Phone*
• Email*
• Date of Service*
  MM slash DD slash YYYY

• This customer satisfaction survey is geared toward any member of the healthcare community who interacted with any of our services. Recently, American Ambulance Service, Inc., provided ambulance transportation to your facility. We hope our services met or exceeded your expectations. The team at American Ambulance are committed to providing excellent emergency medical services to all of our patients. Please take a moment of your time to answer these questions. Your feedback will assist us in continuously improving the quality of care and services we provide.
• Facility Name*
• Date of Service*
  MM slash DD slash YYYY
• 1. American Ambulance personnel arrived on time.
  • Agree
  • Neutral
  • Disagree
• • Were you advised of a delay in our arrival?
  • Yes
  • No
  • N/A
• 2. The American Ambulance team acted in a compassionate and caring manner.
  • Agree
  • Neutral
  • Disagree
• 3. The American Ambulance team were knowledgable and competent.
  • Agree
  • Neutral
  • Disagree
• 4. The American Ambulance team listened to the report given by the facility staff and asked appropriate questions to ensure quality patient care.
  • Agree
  • Neutral
  • Disagree
• 5. The American Ambulance team were polite and respectful.
  • Agree
  • Neutral
  • Disagree
• 6. The American Ambulance team were professional.
  • Agree
  • Neutral
  • Disagree
• 7. The overall quality of care our patient received from American Ambulance was excellent.
  • Agree
  • Neutral
  • Disagree
• 8. If any member of our team especially stood out, please let us know who they are. We would like to show them our appreciation.
• 9. Did you interact with a member of our patient scheduling or dispatch team?
  • Yes
  • No
• • I was greeted professionally
  • Agree
  • Neutral
  • Disagree
• • I was treated politely and with respect
  • Agree
  • Neutral
  • Disagree
• • The team member(s) I interacted with were professional
  • Agree
  • Neutral
  • Disagree
• • The team member(s) kept me updated during any delays or being placed on hold
  • Agree
  • Neutral
  • Disagree
  • N/A
• • Additional Comments about dispatch/scheduling
• 10. Additional Comments
• 11. Contact me about my experience.
  • Yes! Please have an AASI team member contact me to discuss my experience
  • No, please do not contact me.
• Name*
  First Last
• Preferred Method of Contact*
  • Phone
  • Email
• Phone*
• Email*
• Date of Service*
  MM slash DD slash YYYY
• Name
  This field is for validation purposes and should be left unchanged.