Community Ambulance Patient Survey

First Name

Names must be at least 2 characters and can only contain letters.

Last Name

Please provide your last name.

Account Number

Your 7 digit account number is located in the top right corner of your bill.

Date of Service

Questions about your transport

Professionalism of employees.

Friendliness of employees.

Appearance of employees.

Cleanliness of vehicle.

Comfort of ride.

Quality of medical care.

Timeliness of our response.

Questions about our billing staff

Have you interacted with our Billing Team?

Yes No

Were you able to talk to a live person?

Yes No

What was the overall quality of your experience with our billing team?

Additional Feedback

Please share with us any suggestions/comments you have regarding the services provided by Community Ambulance:

Would you like a representative from Community Ambulance to contact you?

Yes No

Name

Phone Number

Email

Send me a copy of this survey.

Best time to contact you