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EMRG Patient Feedback Form

Thank you for visiting our site.

If an EMRG member has recently assisted you during a medical emergency, please take a few minutes and tell us how we did.
Thank You!

Section A

1. In your opinion, did our members arrive on scene within a reasonable amount of time?

Yes No
Comments:

2. Were the EMRG members able to provide you with the care that was required?

Yes No
Comments:

3. Did the EMRG members address all of your questions and concerns?

Yes No
Comments:

4. Did you find your interaction with the EMRG members to be pleasant?

Yes No
Comments:

Section B

Please rate the following items on a scale from 1 to 5:

     1 = Strongly Disagree
     2 = Moderately Disagree
     3 = Neutral
     4 = Moderately Agree
     5 = Strongly Agree

5. The EMRG members made me feel comfortable while providing me with medical assistance.

1 2 3 4 5

6. The EMRG members were able to provide me with the assistance required.

1 2 3 4 5

7. I was clearly informed of my options regarding further medical assistance.
     (eg. going to the Hospital, or accompanied to Health & Wellness Centre, etc.)

1 2 3 4 5

8. I would rate my overall satisfaction with the quality of EMRG's medical assistance as:

1 2 3 4 5

Thank You for your Time!