Feedback Form

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Below is the Feedback Form that we mail out to patients transported by WEMS. Your opinions are very valuable to us and will let us know how we can serve you better.
Also if you want to leave a comment, even if we did not transport you, feel free to use this form.
 
You may hit the reset button at the bottom if you need to start over.
 
WEMS Survey
 
Our goal is to provide you with outstanding care and service here at Hamilton Health Care System. Your responses are vital to our efforts to improve our services. Please take a few minutes to complete our survey.

 

Using a 1 - 5 scale, with 1 being 'Poor' and 5 being 'Outstanding,' N/A meaning 'you have no opinion', how would you rate the:

        Overall quality of care provided by WEMS:

N/A     1         2         3         4         5

        Skill of ambulance staff:

N/A     1         2         3         4         5

        Appearance of ambulance service:

N/A     1         2         3         4         5

        Compassion of ambulance staff:

N/A     1         2         3         4         5

        Explanations/instructions given by ambulance staff:

N/A     1         2         3         4         5

        Response time of ambulance service:

N/A     1         2         3         4         5

Are you a patient or family member:

Patient                 Family member             Other

Please suggest any way, that we could improve our service.

What did we do, that exceeded your expectations.

Date:                        Trip number:   

Name (optional):