Contact - Midlands Air Ambulance Charity

What was the date of your incident?

If you are unsure of the exact date, please include the month and year.

Where did your incident take place?

If other, please specify your incident location

Did you feel safe whilst in the care of Midlands Air Ambulance Charity?

Yes
No
Partly
Unable to answer / cannot remember

Comments (Q3 - Did you feel safe?)

Were you made to feel comfortable by Midlands Air Ambulance Charity?

Yes
No
Partly
Unable to answer / cannot remember

For example, were you given adequate pain relief? Were you kept warm enough?

Comments (Q4 - Were you made to feel comfortable?)

Were you provided with open and honest information about your care / treatment by Midlands Air Ambulance Charity?

Yes
No
Partly
Unable to answer / cannot remember

Comments (Q5 - Were you provided with open and honest information?)

Were you involved in decisions about your care?

Yes
No
Partly
Unable to answer / cannot remember

Comments (Q6 - Were you involved in decisions about your care?)

Were you treated with kindness, compassion, and dignity by Midlands Air Ambulance Charity?

Yes
No
Partly
Unable to answer / cannot remember

Comments (Q7 - Were you treated with kindness, compassion, and dignity?)

How would you rate your overall experience of Midlands Air Ambulance Charity?

Comments (Q8 - Overall experience rating)

After your incident, were you taken to hospital?

Yes
No

Were you airlifted to hospital by Midlands Air Ambulance Charity?

Yes
No
Unable to answer / cannot remember

How did you find the experience on-board the helicopter?

Please include details of your overall feelings. You may want to include details about noises, sights, comfort, smells, temperature, and communication with the aircrew.

you Were the

Did you feel safe in the helicopter?

Yes
No
Partly
Unable to answer / cannot remember

How long did you remain in hospital?

Is there anything you think Midlands Air Ambulance Charity can learn from or improve to provide excellent patient care in the future?

Would you be happy to be contacted by our patient liaison team?

Yes
No

Midlands Air Ambulance Charity has a committed and passionate patient liaison team led by our own clinicians. Their focus is to provide a point of contact for our patients and their relatives/carers.

Full name

Mobile

Telephone

Email

What is your ethnic group? Choose one option that best describes your ethnic group or background.

If you selected 'Any other' ethnic background, please specify

CONSENT

I Agree

I understand that any personal information that I may choose to give in this survey may be processed for the purpose of this survey.

Patient Care & Experience Survey

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