top of page
M19 dark.jpeg

Ambulance Transport Survey

This form may be used in lieu of returning the form that was mailed to you after your ambulance transport by NCEMS. Thank you for taking the time to complete this questionnaire.

​

For a downloadable copy, click here.​

We value your opinions and suggestions. Should you have any questions about the service provided, you may comment at the bottom of this survey. If you would like to remain anonymous, please write "Anonymous" in the name box. Thank you for taking the time to complete this questionnaire. 

1. How would you rate the courteousness and professionalism of our ambulance crew?
Excellent
Very Good
Good
Fair
Poor
2. How would you rate the ambulance crew's medical knowledge and skill?
Excellent
Very Good
Good
Fair
Poor
3. How well did the ambulance crew manage any discomfort or pain?
Excellent
Very Well
Well
Fair
Poor
4. How would you rate the ambulance's timeliness in responding to your emergency?
Excellent
Very Good
Good
Fair
Poor
5. How well did the ambulance crew explain any treatments or tests that were performed?
Excellent
Very Well
Well
Fair
Poor
6. How would you rate the appearance of the ambulance crew and cleanliness of the ambulance?
Excellent
Very Good
Good
Fair
Poor
7. Were you taken to the hospital of your choice?
Yes
No
7a. If no, how well was the explanation of hospital choice explained to you?
Excellent
Very Well
Well
Fair
Poor
bottom of page