We are aware that you may have little or no recollection of your contact with us, but we would be very grateful if you could answer as many of the following questions as possible to enable us to review our work and ensure we are delivering the best possible care.

If you are a friend, family member or caregiver and were at the scene of the incident, we would be grateful to hear your feedback too.

All feedback is passed on to the clinicians who attended your incident. It will also be available to the Care Quality Commission who regulate our service.

This form will take 5-10 minutes to complete.

Required Field*

I am...*

If you are not the patient, please state the patients name below

Your Name*

Your Email*


Date of Incident*

Location of incident*

Can you describe what happened?

Did the crew introduce themselves to you?

Were the crew professional?

Did the crew treat you with dignity and respect in your opinion?

Were you informed of what was happening to you?

If applicable do you feel your wishes were respected?

If you were in pain, was it well managed?

Would you describe your transfer to hospital as reasonably comfortable and safe?

If you traveled to hospital by helicopter, did the crew explain to you what to expect during the journey, such as motion and noise?

Do you feel the treatment you received at the scene made a difference?

Overall how satisfied were you with the care and treatment you received?

If you answered no to any of the questions above, could you please explain why in the space below

If you have any other feedback about your experience, or would like to update us on your condition, please write in the space below

EAAA has an aftercare team who can provide support and advice regarding your incident should you need it and are able to answer any questions you may have about your treatment. We are also able to arrange a visit to meet the crew who attended you if you feel it would aid your recovery. If you would like to hear from us please tick the appropriate box below.
Yes, please contact meNo, please dont contact me

If yes, please tick your preferred contact details and a member of our Aftercare team will be in touch with you soon to discuss your requirements

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