Trinity EMS - Customer Feedback Survey

Name of Facility
Date of Service* (format MM/DD/YYYY)
Was Trinity staff on time? Yes No

One a scale of 1-5 (1 being below average and 5 being excellent), please rate Trinity’s performance in the following areas:
The level of service provided by Trinity’s Dispatch personnel.
The general appearance of Trinity's personnel and uniforms.*
Trinity personnel’s behavior and demeanor towards the patient.*
Trinity personnel’s behavior and demeanor towards staff members.*
The overall condition of the equipment.*
Overall satisfaction with your entire Trinity experience.*

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

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

Would you like a Trinity representative to follow-up with you regarding your experience?
(If yes, please make sure you indicate the name of the facility and date of service above.) Yes No

*Required Field