Pridestar Trinity - Patient Survey

Name

Name of Patient *

Date of Service * +

Day Phone

One a scale of 1-5 (1 being below average and 5 being excellent), Please rate Pridestar Trinity’s performance in the following areas: *

The level of service provided by Trinity’s Dispatch personnel.	12345
The general appearance of Trinity's personnel and uniforms.	12345
Trinity personnel’s behavior and demeanor towards the patient.	12345
Trinity personnel’s behavior and demeanor towards bystanders or family.	12345
The overall condition of the equipment and ambulance.	12345
Trinity’s level of clinical knowledge and expertise.	12345
Trinity’s driving and your ride in the ambulance.	12345
Overall satisfaction with your entire Trinity experience.	12345

Please provide any other comments you would like to share about your Pridestar Trinity experience:

I grant permission for Pridestar Trinity to use my comments for promotional purposes. *

Yes

Would you like a Pridestar Trinity representative to follow-up with you regarding your experience? *

Yes

Please make sure you have entered your name and contact information above