Post Transfer Survey - Dell Children's Medical Center of Central Texas

Transport number*

(Please refer to transport number at bottom of follow up letter.)

Strongly Agree = 5, Agree = 4, Neutral = 3, Disagree = 2, Strongly Disagree = 1

A. Transport was easy to arrange

B. Person triaging the call was polite, respectful and efficient

C. I was given an accurate estimated time of arrival

A. Transport team treated referring staff respectfully

B. Patient was treated appropriately and was packaged efficiently

A. I received a post transport phone call from the team

B. Overall, I am satisfied with this transfer

Submitted by:

First Last

Phone:

Email:

Comments: (If answered 1 or 2 on any items above, please elaborate)