Thank you for taking the time to fill out our survey. Lee County EMS appreciates your feedback and will use it to improve services in the future!

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* 1. Date of service

Date

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* 2. Time of service

Time

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* 3. Patient age group

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* 4. Rate your experience with dispatch when you called 911

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* 5. Did the ambulance arrive in a timely manner?

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* 6. Rate the ambulance staff that assisted you (EMT's and Paramedics)?

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* 7. Did the EMS staff listen to and address all of you and your families concerns?

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* 8. How satisfied are you with the medical care you received by EMS?

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* 9. Was the ambulance clean and comfortable?

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* 10. Do you have any comments about the care you received?

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* 11. Do you have any comments about the crew that assisted you?

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* 12. If any member of our team especially stood out, please let us know who they are and how they stood out.

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* 13. Would you like to have a member of LCEMS administration contact you regarding your experience? If so, please enter your contact information below.

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