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RSVP Medical Transport Service
RSVP Medical Transport Service
Scott Monheimer
2025-01-31T08:00:58-05:00
RSVP Medical Transport Service
Client Satisfaction Survey
Aging Survey RSVP
How many times did you use this transportation service during the last 12 months?
1 to 5 times
6 to 11 times
12 or more times
Did you ever miss an appointment because our office staff made an error in scheduling, or because they were unable to find a driver?
Yes
No
If you answered "Yes", how often did this occur?
When you contacted our office staff, were you treated courteously?
Always
Usually
Sometimes
Never
The Driver was Courteous
Strongly agree
Agree
Disagree
Strongly disagree
The Driver was Punctual
Strongly agree
Agree
Disagree
Strongly disagree
The Driver was Helpful
Strongly agree
Agree
Disagree
Strongly disagree
Has this transportation service improved your access to medical care?
Yes
No
Because this service provides transportation to medical appointments, are you better able to take care of your health?
Yes, this has helped me to IMPROVE my current health
Yes, this has helped me MAINTAIN my current health status
No, this has not affected my ability to take care of my health
Has this transportation service contributed to your ability to remain independent?
Yes, very much
Yes, somewhat
Yes, a little
No, not at all
Don’t know
Which of the following transportation options do you currently use?
Department of Aging & Youth Services
Neighbor or friend
I drive
I call a taxi
Public transportation
I walk to stores or appointments whenever possible
Other
Please specify...
How did you first learn about this transportation service?
Doctors Office
Agency Referral
Church Bulletin
Media
Brochure
Friend
Other
Please explain...
Do you have any other comments about the transportation service?
Optional: Name:
Optional: Phone Number:
Submit Form
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