Ambulance Questionnaire - March 2nd 2008

The Welsh Ambulance Service is building a new partnership with the Welsh Kidney Patients Association. Through a series of measures we are working together to improve the non-emergency transport service for patients and particularly for patients requiring renal dialysis.
Would you please take a few minutes to complete this questionnaire.

How long have you been receiving dialysis ? 1 year 1 - 2 years 3 - 5 years Over 5 years

How long have you been travelling by ambulance ? 1 year 1 - 2 years 3 - 5 years Over 5 years

How many times a week do you travel to hospital/unit ? Once per week Twice per week Three times per week

At what time of day (inbound) ? 06:00 - 09:00 09:00 -12:00 12:00 - 16:00 16:00 - 19:00

At what time of day (outbound) ? 09:00 - 12:00 12:00 - 16:00 16:00 - 19:00 after 19:00

How far do you live from the unit ? 5 miles 5 - 15 miles 15 - 30 miles 30 - 50 miles Over 50 miles

How long does your journey to/from the hospital/unit normally take ? 10 mins 10 -20 mins 20 - 30 mins 30 - 45 Mins Over 45 mins

What ambulance transport do you usually use ? Ambulance Car Single Person Ambulance Double Person Ambulance

How long do you wait on average for transport home after treatment ? 10 mins 10 -20 mins 20 - 30 mins 30 - 45 Mins Over 45 mins

How satisfied are you with the service that you receive from the Welsh Ambulance Service ?

Please pick your score from 1 - 10 with 10 being the highest. 1 2 3 4 5 6 7 8 9 10

What could we do to improve our service : Please type in your comments in the box below.

Comments :

THANK YOU FOR YOUR PARTICIPATION

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