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Patient feedback

We would be greatful if you would answer the following questions regarding your experience with our patient transport services. Your feedback is important to us for our continuous service improvement.

Thank you for completing the form. Your submission has been accepted. We will be in touch soon.

– Elite Medical Team

How likely are you to recommend our patient transport service to friends and family if they needed similar care or treatment?

1 - Extremely likely 2 - Likely 3 - Neither likely nor unlikely 4 - Unlikely 5 - Extremely unlikely 6 - Don't know

What is the main reason for the answer you have chosen?

Which county were you collected from?

Which hospital/clinic did you attend?

Who usually books your non-emergency transport?

GP Hospital Yourself Carer/relative Other

If you booked the transport yourself, did you find it easy to do?

Yes No Not applicable

Did you arrive for your appointment on time?

More than 30 minutes early 15-30 minutes early On time 15-30 minutes late More than 30 minutes late

Did your transport home leave on time?

More than 30 minutes early 15-30 minutes early On time 15-30 minutes late More than 30 minutes late

Was the vehicle...

Clean and tidy?

Yes No

Suitable for your needs?

Yes No

Comfortable?

Yes No

Driven carefully?

Yes No

Did the transport crew escort you to the reception desk of your destination and ensure that staff were made aware of your arrival?

Yes No Not required

Overall how satisfied were you with the quality of service you received?

Very satisfactory Above satisfactory Satisfactory Unsatisfactory Very unsatisfactory

Any other comments?

There is now a short section of questions about you. This is entirely voluntary but by completing it you will help us understand more about our patients and also meet our duties under the Equality Act.

How old are you?

14-16 17-21 22-29 30-39 40-49 50-59 60-74 75+

What is your gender?

Male Female Prefer not to say

Do you consider yourself to have a disability?

Yes No Prefer not to say

Do you consider yourself to have a mental health, dementia or learning disability diagnosis?

Yes No Prefer not to say

Your Ethnicity

White British White Irish Other White White & Black Caribbean White & Black African Mixed - any other background White & Asian Asian or Asian British - Indian Asian or Asian British - Pakistani Asian or Asian British - Bangladeshi Asian or Asian British - Caribbean Asian or Asian British - African Asian or Asian British - Any other black background Other Ethnic Groups - Chinese Other Ethnic Groups - Any other Other Mixed Background Prefer not to say

Your Religion or Belief?

Buddhist Christian (including Church of England, Catholic, Protestant and all other Christian denominations) Hindu Jewish Muslim No religion Sikh Prefer not to say Any other religion or belief

Please tell us whether you consider yourself to be any of the following (please tick all that apply or leave blank if none apply)

SCAS staff member SCAS volunteer Public Member Governor Staff member from other NHS organisation Councillor Local Healthwatch Member Patient (rare use of patient transport services) Patient (regular use of patient transport services) GP MP Mayor

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