Exit this survey South Walton Fire District Patient Satisfaction Survey 1. Default Section Question Title * 1. Date of Service Date you required a medical response from the South Walton Fire District. Date Question Title * 2. What is the patient's age? Under 18 18 to 30 31 to 44 45 to 54 55 to 64 65 or older Question Title * 3. The person you called for service (911 Center Dispatcher) Excellent Good Fair Poor N/A Helpfulness of the 911 Dispatcher you called for ambulance services Helpfulness of the 911 Dispatcher you called for ambulance services Excellent Helpfulness of the 911 Dispatcher you called for ambulance services Good Helpfulness of the 911 Dispatcher you called for ambulance services Fair Helpfulness of the 911 Dispatcher you called for ambulance services Poor Helpfulness of the 911 Dispatcher you called for ambulance services N/A Concern shown by the 911 Dispatcher Concern shown by the 911 Dispatcher Excellent Concern shown by the 911 Dispatcher Good Concern shown by the 911 Dispatcher Fair Concern shown by the 911 Dispatcher Poor Concern shown by the 911 Dispatcher N/A 911 instructions were clear and concise until the paramedics arrived 911 instructions were clear and concise until the paramedics arrived Excellent 911 instructions were clear and concise until the paramedics arrived Good 911 instructions were clear and concise until the paramedics arrived Fair 911 instructions were clear and concise until the paramedics arrived Poor 911 instructions were clear and concise until the paramedics arrived N/A Comments (describe positive or negative experiences) Question Title * 4. The Ambulance Excellent Good Fair Poor N/A Ambulance response time Ambulance response time Excellent Ambulance response time Good Ambulance response time Fair Ambulance response time Poor Ambulance response time N/A Cleanliness of the ambulance Cleanliness of the ambulance Excellent Cleanliness of the ambulance Good Cleanliness of the ambulance Fair Cleanliness of the ambulance Poor Cleanliness of the ambulance N/A Comfort of the ambulance ride Comfort of the ambulance ride Excellent Comfort of the ambulance ride Good Comfort of the ambulance ride Fair Comfort of the ambulance ride Poor Comfort of the ambulance ride N/A Comments (describe positive or negative experiences) Question Title * 5. Firefighter/Paramedic personnel Excellent Good Fair Poor Showed genuine concern for my situation Showed genuine concern for my situation Excellent Showed genuine concern for my situation Good Showed genuine concern for my situation Fair Showed genuine concern for my situation Poor Handled themselves professionally Handled themselves professionally Excellent Handled themselves professionally Good Handled themselves professionally Fair Handled themselves professionally Poor Displayed professional and neat appearance Displayed professional and neat appearance Excellent Displayed professional and neat appearance Good Displayed professional and neat appearance Fair Displayed professional and neat appearance Poor Treated me with respect, compassion, and care for my injury/illness Treated me with respect, compassion, and care for my injury/illness Excellent Treated me with respect, compassion, and care for my injury/illness Good Treated me with respect, compassion, and care for my injury/illness Fair Treated me with respect, compassion, and care for my injury/illness Poor Offered quality, competent care throughout treatment Offered quality, competent care throughout treatment Excellent Offered quality, competent care throughout treatment Good Offered quality, competent care throughout treatment Fair Offered quality, competent care throughout treatment Poor Comments (describe positive or negative experiences) Question Title * 6. Overall Assessment Excellent Good Fair Poor How well did our staff work together to care for you How well did our staff work together to care for you Excellent How well did our staff work together to care for you Good How well did our staff work together to care for you Fair How well did our staff work together to care for you Poor The provided services were worth the fees charged The provided services were worth the fees charged Excellent The provided services were worth the fees charged Good The provided services were worth the fees charged Fair The provided services were worth the fees charged Poor Quality of care provided by the SWFD Quality of care provided by the SWFD Excellent Quality of care provided by the SWFD Good Quality of care provided by the SWFD Fair Quality of care provided by the SWFD Poor How would you rate your overall experience with the South Walton Fire District How would you rate your overall experience with the South Walton Fire District Excellent How would you rate your overall experience with the South Walton Fire District Good How would you rate your overall experience with the South Walton Fire District Fair How would you rate your overall experience with the South Walton Fire District Poor Comments (describe positive or negative experiences) Question Title * 7. Any suggestions to enhance our service? Question Title * 8. May we contact you regarding your comments or concerns No Yes Next
