Customer Feedback

* indicates a required field. The form will not submit until all required data has been filled out/selected.

Name of Facility
Date of Service (MM/DD/YYYY)*
MM slash DD slash YYYY
Was the MedStar staff on time?
- Yes
- No
On a scale of 1-5 (1 being below average and 5 being excellent) please rate MedStar’s performance in the following areas:
The level of service provided by MedStar’s Dispatch personnel.*
The general appearance of MedStar’s personnel and uniforms.*
MedStar personnel’s behavior and demeanor towards the patient.*
MedStar personnel’s behavior and demeanor towards staff members.*
The overall condition of the equipment.*
Overall satisfaction with your entire MedStar experience.*
Please provide any other comments you would like to share about your MedStar experience:
- I grant permission for MedStar to use my comments for promotional purposes.
Would you like a MedStar representative to follow-up with you regarding your experience? (If yes, please make sure you indicate the name of the facility and date of service above.)
- Yes
- No
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