Required fields are marked with asterisks (*)

Community Paramedicine Client Survey

This survey is for people who have recieved care from Perth County's Community Paramedicine (Mobile Integrated Health Team).

Thank you for taking the time to provide valuable feedback to our program.

In general, would you say your health is:

Excellent

Very Good

Good

Fair

Poor

The Community Paramedics provided me with helpful advice and information on how to maintain or improve my own health and well-being, or the health and well-being of the person I care for.

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

The Community Paramedics improved my knowledge about health and social services that are available.

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

I feel better prepared to deal with concerns I may have in the future about my own health and well-being, or the health and well-being of the person I care for.

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

I feel better prepared to deal with concerns I may have in the future about my own health and well-being, or the health and well-being of the person I care for.

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

The Community Paramedics listened to my concerns

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

The community paramedics took the time to answer my questions.

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

The community paramedicine program has aided my overall health and well-being, or the health and well-being of the person I care for.

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

Overall how satisfied are you with the service and care provided by the Community Paramedic(s)?

Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

Would you recommend this service to others?

Yes

What do you see as the overall benefits to this program?

Do you have suggestions for how this program could serve you better?

Would you like one of our team members to contact you to follow-up regarding your concerns?

Yes

Personal information on this form is collected pursuant to Section 11 of the Municipal Act, 2001. It is to be used for the purpose of administering the County’s Community Paramedicine program. Any Questions regarding the collection, use, and retention of personal information on this form can be directed to the Commander of Mobile Integrated Health, County of Perth, 480 Douro Street, Stratford, Ontario, N5A 0E6, 519-271-0531.

Form Builder

Community Paramedicine Client Survey