Sandusky County EMS
Patient Satisfaction Survey

Background Information

Thanks for taking the time to complete our 5-minute survey. Your responses help us to improve our care and provide positive outcomes for our patients. We appreciate your honest feedback.

Question Title

* Who is completing the survey?

The Patient

Patient's Spouse

Patient's Family

Other (please specify)

Question Title

* Date of Service

Date

Question Title

* What is the patient's gender?

Male

Female

Question Title

* What is the patient's age?

Under 18

18 to 30

31 to 44

45 to 54

55 to 64

65 or Older