Northshore Ambulance

PATIENT FEEDBACK

Hello,
Please take a few moments to review this questionnaire. Please tell us how you feel about the services you received from Northshore Ambulance, Inc. We need to know where we are doing well and where we need to improve. This is extremely important to us.

Please complete this questionnaire. Your response is appreciated.

Sincerely,

Robert A. Dionne
President and Chief Executive Officer


Using a scale of 1 to 5 with 1 being poor and 5 being excellent, please answer the following questions:
1: Performance of the ambulance or chair car crews
2: Politeness of the ambulance or chair car crews
3: Appearance of the ambulance or chair car crews
4: Cleanliness of the ambulance or chair car
5: Performance of the ambulance or chair car equipment
6: Overall, how would you rate our service

Name/address (optional) Name:
Address:
City:
Additional comments: Please add any recommendations that you feel will enhance our ability to improve: