Survey

The membership of Lexington Park Volunteer Rescue Squad would like to thank you for taking the opportunity to complete this brief survey. Our crews strive to provide the best care possible to the community and value your input. The information contained in this survey will remain confidential unless written content is received. Mandatory fields are denoted by a red asterisk *.

Date of Emergency: *
Time of Emergency: *
Location of Emergency: *
Responding Unit:	EMS 39 Utility 38 Utility 39 Ambulance 387 Ambulance 388 Ambulance 389 Ambulance 396 Ambulance 397 Ambulance 398 Ambulance 399 Not Exactly Sure
1. When you called 911 was the dispatcher helpful?		Yes No
If No could you please elaborate?
2. Do you feel that LPVRS and other members of the St. Mary's County EMS System responded to your emergency in a timely manner?				Yes No
If No could you please elaborate?
3. How would you rate our care?
	Poor	Fair	Good	Excellent
Comments
4. Please rate our Providers on the following attributes:
	Poor	Fair	Good	Excellent
Professional
Friendly/Courteous
Concerned/Caring
Appearance/Dress
Knowledgeable/Skilled
5. Did our Providers listen to what you had to say?		Yes No
If No could you please elaborate?
6. Did our Providers explain what they were doing?		Yes No
If No could you please elaborate?
7. Did you feel confident in the care you received?		Yes No
If No could you please elaborate?
8. Did our Providers make you feel better, or relieve some of your pain?			Yes No
If No could you please elaborate?
9. Is there anything else you'd like to add?
Name: *
Relationship to patient: *
Contact Number:
Contact Email:
If you stated that you were less then satisfied would you mind if we contacted you via the information above?				Yes No
For security protection, please provide the SUM for the mathematical equation:
If you have any further questions regarding our service please contact us at customerservice@lpvrs.org.

Back