Patient Feedback Survey - Private Ambulance UK

Phone

This field is for validation purposes and should be left unchanged.

Name*

First Last

Email*

Journey Date

Day

Month

Year

First part of postcode for pickup

We would like you to think about your recent contact with Private Ambulance UK

Q1 - Overall, how was your experience of our service?*

Very Good

Good

Neither good nor poor

Poor

Very Poor

Don't Know

Please can you tell us why you gave this answer?

Please confirm whether you are happy for your comments to be made public:*

Yes

Q2 - Are you the patient?*

Yes

If no, what is your relationship:

Q3. How quickly did we answer your call or enquiry?*

Quickly

It took a long time

My call was not answered

Unable to say

Q4. Were you clearly informed of the date and time of your booking?*

Yes

Unable to say

Q5. How would you rate the booking system?*

Very Good

Good

Neither good nor poor

Poor

Very Poor

Don't Know

Q6. Did the service staff introduce themselves to you?*

Yes

Unable to say

Q7. How would you describe the length of time your journey took?*

Very Good

Good

Neither good nor poor

Poor

Very Poor

Don't Know

Q8. Did you arrive on time for your appointment?*

Very early (over 60 minutes)

Early (30 - 60 minutes)

On Time

Late (0 - 60 minutes)

Very late (over 60 minutes)

Not applicable

Q9. If we were late, did we contact you?*

Yes

Not applicable

Q10. How long did you have to wait for your return transport after your appointment?*

0 -15 minutes

15 -30 minutes

30 - 45 minutes

45 - 60 minutes

Over 60 minutes

Not applicable

Q11. How did you find the communication between the Patient Transport Service and the hospital / clinic?*

Very Good

Good

Neither good nor poor

Poor

Very Poor

Unable to say

Q12. How would you describe the comfort of the vehicle?*

Very Good

Good

Neither good nor poor

Poor

Very Poor

Unable to say

Q13. How would you describe the suitability of the vehicle*

Very Good

Good

Neither good nor poor

Poor

Very Poor

Unable to say

Q14. How would you describe the Cleanliness inside the vehicle?*

Very Good

Good

Neither good nor poor

Poor

Very Poor

Unable to say

Q15. How would you describe the attitude of the staff?*

Excellent

Good

Poor

Unable to say

Q16. Did the staff treat you with dignity and respect?*

Yes - definitely

Yes - to some extent

No - I was not treated with dignity and respect

Unable to say

Q17. Did the staff drive safely?*

Yes

Unable to say

Q18. Did the staff offer assistance if required?*

Yes

Not Required

Unable to say

Would you like to compliment the service or staff?

If you wish to send a separate note of thanks to the call handler or staff involved, you may add your comments to the below box, please also include your name and contact details to make sure your compliment is passed on to the staff member.

Comments

Consent

I consent to my information being held and any comments passed to the team member to read.

Would you like to inform us of a concern or complaint?

All comments received are used to monitor and improve the services provided by the Trust. If you have a concern or complaint about the service you have received and would like us to contact you, please complete the below box and provide your name and telephone number.

Consent

I consent to my details being held by Private Ambulance UK and I wish to be contacted by the Patient Experience Team to register my concerns and initiate the feedback process

Name

First Last

Phone

Address

Street Address City County Post code

Would you like to compliment the service or staff?

Would you like to inform us of a concern or complaint?

Info

Services