Patient Evaluation Questionnaire

Leave This Blank:

Jefferson County Ambulance Service strives to provide the best possible pre-hospital care. We take pride in ensuring each and every person is treated with courtesy, compassion and with the latest advancements in pre-hospital, emergency care. To deliver the highest quality standard of care we need your feedback. Please take a few moments to complete this survey. Your honest evaluation helps to improve our service delivery and quality.
Please complete the evaluation below:
Service
The Ambulance
The Office Staff
Overall Impression of Jefferson County EMS
Thank you for taking the time to complete this questionnaire. If you would like to speak with someone or have a question, contact James Tweed at (785)403-0166.
 
* indicates required fields.