Patient Feedback Form
At Codeblue, we are committed to providing safe, respectful, and high-quality care. Your feedback is very important to us as it helps us understand what we are doing well and where we can make improvements. Please take a few minutes to answer the questions below. All responses are treated confidentially.
How satisfied were you with the care you received from Codeblue?
*
1
2
3
4
5
Were you treated with respect and dignity by our staff?
*
1
2
3
4
5
Did our staff explain things clearly and in a way you could understand?
*
1
2
3
4
5
How would you rate the professionalism of our staff?
*
1
2
3
4
5
Was the environment (vehicle/setting) clean and safe?
*
1
2
3
4
5
Did you feel involved in decisions about your care and treatment?
*
1
2
3
4
5
Please tell us what we did well
Please tell us where we could improve
If you would like us to follow up with you, please leave your details below (optional)
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Submit
Should be Empty: