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* 1. Date of Transport

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* 2. Patient Name

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* 3. How would you rate the professionalism / appearance of the crew?

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* 4. How would you rate the cleanliness of the ambulance and/or equipment?

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* 5. Were you treated with courtesy and respect?

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* 6. How well did the provider explain your care and answer your questions?

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* 7. How would you rate your overall experience with the Highland County Volunteer Rescue Squad

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