• Screening Checklist for Visitors and Employees

    Patient Satisfaction Survey

    This survey is intended for patients who have recently utilized the 9-1-1 Ambulance Service of Waterloo Fire Rescue. This survey includes 17 total questions. No question requires an answer, all feedback is appreciated.
    • Patient Demographics: 4 Questions 
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    • 9-1-1 Call: Prior to EMS arrival: 4 Questions 
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    • EMS/Transport Experience: 5 questions 
    • Billing Process: 3 Questions 
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    • Submit Form: 1 question 
    • Thank you for completing the survey. Someone will be contacting you within 72 hours if a call was requested.

    • Should be Empty: