Air Link Patient/Family Satisfaction Survey Question Title * 1. Transport date? 1 = strongly disagree 3 = disagree 5 = neutral 7 = agree 10 = strongly agree Question Title * 2. Transport crew introduced themselves 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 Question Title * 3. Courteous/professional transport crew behavior 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 Question Title * 4. Neat appearance of transport crew 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 Question Title * 5. Hearing protection and safety briefing provided to the patient 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 Question Title * 6. Concern for patient comfort by transport crew 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 Question Title * 7. Pain management addressed by the transport crew 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 Question Title * 8. Knowledgeable/skillful transport crew 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 Question Title * 9. I felt safe during this transport 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 Question Title * 10. Overall satisfaction 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 Question Title * 11. I would recommend this service for critical care transport in the future 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 Question Title * 12. Comments on this transport. Also, please share your ideas on how we can improve our organization. We encourage your participation and value your time and input. Question Title * 13. Contact Information (Optional) Name Phone # Email Question Title * 14. Do you have a concern with this transport that you would like to be contacted about? Yes No Question Title * 15. I am willing to be contacted about sharing my story in Air Link's publications or educational events. Yes No Question Title * 16. How likely is it that you would recommend this company to a friend or colleague? Not at all likely Extremely likely 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Done
