Patient Care & Experience Survey (for Relatives, Carers and Loved Ones)

Introduction

If you are a close family member, friend, carer, or loved one of someone who has been treated by Midlands Air Ambulance Charity, as a patient, we want to learn more about your and their experiences. We are committed to providing excellent patient care and your answers will be used to improve our service for our future patients.

Our relatives' survey should take just 5 - 10 minutes to fill in. While filling this in, please note Midlands Air Ambulance Charity's clinical team wear red flight suits and are not part of the ambulance service (who wear green uniforms). Your answers should concentrate on our clinicians and the treatment they gave your loved one.

SECTION 1: ABOUT THE EXPERIENCE

Question Title

* 1. What is the patient's name? (We ask for this information for the purposes of matching your responses to the correct patient’s details. This data will only be processed and used for the purpose of this survey.)

Patient Care & Experience Survey (for Relatives, Carers and Loved Ones)

Introduction

Question Title

* 1. What is the patient's name? (We ask for this information for the purposes of matching your responses to the correct patient’s details. This data will only be processed and used for the purpose of this survey.)

Question Title

* 2. What was the date of the incident? (Please write in the box below. If you are unsure of the exact date, please include the month and year.)

Question Title

* 3. Where did the incident take place? (Please write in the box below. If you do not know the location, please include the county.)