2. We want to hear from you!
   Please tell us about your EMS experience. The information you provide will help us improve our department.
4. 1. How satisfied were you with the 911 call takers' instructions in assisting you prior to the paramedics arrival?*
   -- Select One --Very DissatisfiedDissatisfiedNot ApplicableSatisfiedVery Satisfied
5. 2. How satisfied were you with the time it took the Paramedics to arrive to your emergency?*
   -- Select One --Very DissatisfiedDissatisfiedNot ApplicableSatisfiedVery Satisfied
6. 3. How satisfied were you that the Paramedics listened to you and explained what they were doing?*
   -- Select One --Very DissatisfiedDissatisfiedNot ApplicableSatisfiedVery Satisfied
8. 4. How satisfied were you that the Paramedics displayed a caring attitude for your situation?*
   -- Select One --Very DissatisfiedDissatisfiedNot ApplicableSatisfiedVery Satisfied
9. 5. How satisfied were you with the Paramedic's attempt to manage your pain or discomfort?*
   -- Select One --Very DissatisfiedDissatisfiedNot ApplicableSatisfiedVery Satisfied
10. 6. How satisfied were you with the level of courtesy and professionalism of the Paramedics?*
    -- Select One --Very DissatisfiedDissatisfiedNot ApplicableSatisfiedVery Satisfied
12. How likely would you tell a family member or friend you had a positive experience with EBR EMS? 10 is extremely likely, 5 is neutral and 1 is not at all likely. *
    -- Select One --1- Not likely2345- Neutral678910- Extremely likely
14. What were the key reasons you scored us the value in the previous question?*

    1. Response Time
    2. Explained Actions
    3. Professionalism
    4. Caring Attitude

    1. Concerned Condition
    2. Care Provided
    3. 911 Instructions

    1. Courtesy
    2. Manage Pain/Discomfort
    3. Listened to Me and Family

    1. Gentle Lifting/Moving
    2. Hospital Destination
    3. Other
16. Compliments and feedback
    Please utilize this form to leave compliments or feedback about our department. (A date/time of incident, Location, or Patient name would be helpful.) Thank you.
18. First Name*
19. Last Name*
21. Contact Phone Number*
22. Email Address
23. How did you find out about this survey?*
    -- Select One --A card the Paramedic gave meThe EBR EMS websiteQR code on my EMS billAn email I receivedSocial MediaA phone call I receivedSomeone told me about it
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24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

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