Patient Survey

As we strive to continuously improve our services, your feedback is important to us. Please complete the Online Patient Survey below, if you or a family member was treated and/or transported by Rock Township Ambulance District.

Alternatively, you may download, complete, and print the same survey here: Patient Survey

Once completed, please mail, fax or email the survey to:

ROCK TOWNSHIP AMBULANCE DISTRICT
6707 St. Luke's Church Road
Barnhart, MO 63012
FAX: (636) 296-8357
EMAIL: rtadpatientsurvey@rocktownship.com 

 

ROCK TOWNSHIP AMBULANCE DISTRICT ONLINE PATIENT SURVEY

When did this service occur? (required)

RTAD Incident # (required)

What time of day was your emergency? Morning (4am-12pm) Afternoon (12pm-8pm) Night (8pm-4am) 

The dispatcher (emergency operator) handled by call in a professional manner. Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Applicable 

The ambulance responded in a timely manner. Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Applicable 

The ambulance crew acted professionally towards me. Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Applicable 

The ambulance crew was polite and respectful to me. Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Applicable 

The ambulance crew was clean and well-prepared.Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Applicable 

The ambulance crew listened to the needs and concerns of my family, friends, and me. Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Applicable 

My injury and/or illness was explained to me, treated appropriately, and my pain was adequately managed. Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Applicable 

I was taken to the hospital of my choice? Yes No 

If you answered no, please explain:

While in the back of the ambulance, the equipment seemed in working order and the ambulance was clean. Yes No 

If you answered no, please explain:

Did you need to contact our billing company with questions or concerns? Yes No 
If “yes”: Were the billing personnel polite? Yes No 
If “yes”: Were the billing personnel able to answer your questions? Yes No 

Overall, I was satisfied with the emergency medical services provided to me by Rock Township Ambulance District?
Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree Not Applicable 

How can we further improve our emergency medical services? Please comment below.

Would you like a representative from Rock Township Ambulance District to contact you? Yes No 
If "yes": Name (required):

Email (required)

Telephone Number (required):