Patient Satisfaction Survey
Why do we survey patients?
Your opinion matters!
At Village Ambulance Service, our goal is to exceed your service expectations. That is why we regularly survey our patients to determine what we are doing right…and what could use some improvement. The results from these surveys are one of our most important patient-satisfaction measurement tools. Being able to hear about the quality of our services from the patient’s perspective allows us to make meaningful changes in our clinical treatments and in the way we do our jobs.
We greatly value our patients’ feedback. The comments we receive from our patients tell a story of their experiences here at VAS – a story we want and need to hear. As a matter of fact, we take the time to read every comment on the surveys.
If you would like to receive a hard copy of the patient satisfaction survey in the mail, please contact us at 413-458-4889 and we will arrange to have one sent to you.
Thank you for helping us to provide you with the best possible patient care experience.
____________________________________________________________________
Privacy Policy
VAS will not sell, trade, rent or release your personal information (name, email address, telephone, etc.) to others without your consent.
This site may contain links to other sites, however VAS is not responsible for the privacy practices or the content of such web sites.
We respect and work to protect your privacy. If you have any questions about this privacy statement, the practices of this site, or your dealings with VAS you may contact us.
Demographics
Patient Name (optional):
Person completing survey (optional):
Date of service (optional):
E-mail address (optional):
Telephone number (optional):
Reason for ambulance (optional):
Which hospital/care center were you transported to? (optional):
Survey Questions:
*Required Fields
*1. How many times have you requested service from Village Ambulance Service?
1 times
1-5 times
5-10 times
More than 10 times
*2. After requesting the ambulance (private or 9-1-1), did Village Ambulance Service arrive in a timely fashion?
Yes
No
*3. How would you rate the attitude of the EMTs/Paramedics who helped you?
Very courteous and professional
Courteous and professional
Uncourteous and unprofessional
Very uncourteous and unprofessional
4. Which age group do you fit into?
18 and under
19-30
31-40
41-50
51-65
66 and older
5. What is your gender?
Male
Female
6. What is your race?
Asian/Pacific Islander
Black/African-American
Caucasian
Hispanic
Native American/Alaska Native
Other/Multi-Racial
Decline to Respond
*7. How satisfied were you with the medical treatment you received?
Very Satisfied
Satisfied
Neutral
Dissatisfied
Very Dissatisfied
*8. How comfortable was the ambulance ride during your transport?
Very uncomfortable
Somewhat uncomfortable
Comfortable
Very comfortable
*9. Did the EMTs/Paramedics listen and address all of you and/or your family's concerns?
All our concerns were addressed
Some of our concerns were addressed
They could have done a better job addressing our concerns
They did not address any of our concerns
*10. Overall, how would you say your friends and/or family were treated by Village Ambulance Service personnel?
Very Well
Good
Acceptable
Poorly
Very Poorly
11. Do you have any questions or comments regarding your experience with Village Ambulance Service?
12. Would you like to be contacted in regards to your experience with Village Ambulance Service?
