Skip to content
About
Who We Are
Our Team
Employment
Gallery
Who We Serve
ACAA Information
Base Locations
How We’ve Helped
Success Stories
Submit Your Story
Submit Your Feedback
Menu
About
Who We Are
Our Team
Employment
Gallery
Who We Serve
ACAA Information
Base Locations
How We’ve Helped
Success Stories
Submit Your Story
Submit Your Feedback
Contact
Submit Your Feedback
Client Satisfaction Survey
Date
*
MM slash DD slash YYYY
Base
*
Lac La Biche
Edmonton
Fort McMurray
Slave Lake
Client Centred Care
The air medical crew was respectful and caring.
Yes
No
N/A
The air medical crew helped me understand my condition and my options for care or treatment.
Yes
No
N/A
The air medical crew answered my questions and provided information when I needed it.
Yes
No
N/A
The air medical crew explained the procedures they performed in a manner that I could understand.
Yes
No
N/A
The air medical crew involved me in making decisions about my care.
Yes
No
N/A
The air medical crew made sure I agreed before starting any treatment or medical procedures.
Yes
No
N/A
Provider Competency
I feel confident in the abilities of the air medical crew who provided my care.
Yes
No
N/A
I feel well-cared for by the air medical crew who provided my care.
Yes
No
N/A
The aircraft is clean and comfortable.
Yes
No
N/A
Infection Control
The air medical crew performed proper hand hygiene or wore gloves before giving me medical care or treatments.
Yes
No
N/A
If any members of our staff were especially helpful, please let us know who they were.
Additional comments or suggestions:
Do you wish to be contacted by ACAA?
No
Yes
Name
*
First
Last
Email
*
*If you would like to fill out a Complaint Form please request additional form from the Air Medical Crew or contact Kimberly Belanger
(780) 404-5085.
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.
Δ
