Marion County Ambulance Satisfaction Survey

Patient Number (required)

Date of Call (required)

Please rate the severity of your pain/problem when the Paramedics first arrived. (required)

Please rate the severity of your pain/problem when you arrived at the Emergency Room. (required)

The Paramedic crew acted in a compassionate and caring manner: (required)

The Paramedic crew presented themselves professionally: (required)

The Paramedic crew clearly explained the care and procedures they were providing and responded to questions: (required)

The paramedic crew was thorough in their examination of your problem: (required)

How well did the crew work together to care for you: (required)

How would you rate the quality of care provided: (required)

Was the ambulance ride comfortable and the unit clean: (if not please explain below) (required)

If you were not completly satisfied with the cleanliness or ride of the ambulance please use the space provided below to explain: (required)

Do you feel you received great service for your value: (required)

Please comment on your overall expierience with Marion County Ambulance District: (required)

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