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Manchester Volunteer Rescue Squad

Survey Questions

Recently, Manchester Volunteer Rescue Squad (MVRS) responded, treated, and transported you or a family member as a result of an emergency. The members at MVRS are committed to providing professional emergency medical services to all of our patients. We appreciate you taking the time to share your recent experience with us. 

This survey should take approximately 5 minutes to complete, and your feedback will assist us in continuously improving the quality of care and services we provide. 

"*" indicates required fields

This field is for validation purposes and should be left unchanged.
Date of Incident / 911 Call:*
Time of Incident / 911 Call
:
Street Address of Incident*

Service Delivery

Please rate your recent experience with Manchester Volunteer Rescue Squad. For each statement, check the circle that corresponds to the level of care you received. If a question does not apply, please select N/A. there is space provided at the end of the survey to offer additional comments.
1. Please rate your experience with the 911 Center:
Answer time from the 911 dispatcher.*
Courtesy of the 911 dispatcher.*
Usefulness of the instructions provided by the 911 dispatcher.*
2. Please rate your experience with MVRS:
MVRS response time to your incident / 911 call.*
MVRS personnel's professionalism.*
MVRS personnel's knowledge of your complaint.*
Quality of care provided by MVRS personnel.*
Concern MVRS personnel showed for your questions or worries.*
Concern MVRS personnel showed for the needs of your family and friends.*
Degree to which MVRS personnel explained the procedures they performed in a manner that you could understand.*
Cleanliness of the MVRS ambulance and equipment.*
Quality of the driver's skill to provide a comfortable and safe ride to the receiving facility.*
Transport time from the call location to the receiving facility*
Overall satisfaction of the service you received from MVRS.*
3. The overall actions of MVRS personnel caused my situation to:*

Billing

1. Please rate your experience with the billing company:
Ease of contacting a billing representative.*
Courtesy of the billing representative.*
Time frame of your billing process to be completed.*
2. Were you provided a copy of our Notice of Privacy Practices?*
3. Were you told about the Chesterfield Fire and EMS Passport Program?*

Additional Comments

Contact Information

Name*
Address*
Do you wish to be contacted by Manchester Volunteer Rescue Squad regarding this survey or your experience?*