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Refer a Patient

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Transport Feedback form

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Thank you for accessing our transport feedback form online. Your input helps us to identify opportunities for improvement as we strive for service and care excellence. Please identify your site and evaluate our service by responding to the following:

Referring Facility:

Date of Transfer:

Type of transport service requested:

Peds

NICU

Other

Ease of arranging transport for your patient:

Poor

Fair

Good

Very Good

Excellent

Not Applicable/I don't know

Quality of communication between Children’s team and our own prior to arrival:

Poor

Fair

Good

Very Good

Excellent

Not Applicable/I don't know

Timeliness of transport team's arrival based on distance:

Poor

Fair

Good

Very Good

Excellent

Not Applicable/I don't know

Accuracy of ETA and/or update of ETA if delays were expected:

Poor

Fair

Good

Very Good

Excellent

Not Applicable/I don't know

Quality of the stabilization effort and interventions by Children’s team at our site:

Poor

Fair

Good

Very Good

Excellent

Not Applicable/I don't know

Quality of Children’s team communication and collaboration with our team on site:

Poor

Fair

Good

Very Good

Excellent

Not Applicable/I don't know

How might we improve our transport service to you in the future?

If you would like someone to contact you regarding this transport, please list your name and email address below:

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Call 612-343-2121 or 1-866-755-2121

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