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Feedback Survey

  1. Please take a few minutes to fill out and mail this survey back to us. We value you input and are striving to make improvements to provide the best quality of care. Thank you in advance.

    The following questions apply to the Torrington Ambulance Service:

  2. Please rate the following 5 questions, with 1 being very poor and 5 being very good.

  3. 3) Overall rating of the ambulance service:

  4. 4) How would you describe the overall cleanliness of the ambulance:

  5. 5) The Medic who treated me:

  6. 5a.) Provided care in a courteous and respectful manner:

  7. 5b) Explained all medical procedures:

  8. 5c) Was professional and knowledgeable:

  9. 6) During the trip to the hospital:

  10. 6a) I was made comfortable:

  11. 6b) I felt safe:

  12. 7) How would you rate the response time from when call was placed to the arrival of ambulance:

  13. Please answer the following either "yes" or "no" and please explain when asked:

  14. 8) Did you receive a bill for services?

  15. 9) Was your insurance carrier billed for service provided?

  16. 10) Do you feel the charges were fair for the service provided?

  17. 11) Would you recommend this ambulance service to a friend or family?

  18. 12) Have you ever visited the Torrington EMS website? (www.torringtonems.org)

  19. 12a) If "no" to above question, is it because you do not know website address?

  20. 12b) Is it due to not having internet access?

  21. 15) Would you like to be contacted by the EMS Director about any of your responses in this survey?

  22. Leave This Blank:

  23. This field is not part of the form submission.