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Provider Evaluation Survey

Periodically, Med-X performs quality assurance surveys for all of our network providers. This allows Med-X to continually provide excellent service to our clients. Your feedback is a vital part of our quality assurance program. Please take the time to complete this survey and return it to us in the envelope provided. Please remember, we are here to make your recovery as comfortable as possible. If a provider is not performing up to your expectations, please call us right away.
1. Did you receive a Welcome Kit and Letter from Med-X?
 
2. Were you contacted by a Med-X Transportation Coordinator to discuss your transportation needs?
 
3. For your most recent transport, was your transport on time?
 
If no, how late did your transport arrive?  
4. Did your transport arrive at your appointment on time?
 

 
5. Was the vehicle clean and in proper working order?
 

6. Were the drivers and attendants uniformed or professionally dressed?
 

7. Were you contacted by the provider?
 

For the next questions, please use the following scale
1-Very Dissatisfied 2-Somewhat Dissatisfied 3–Good 4-Very Good 5-Excellent
8. Overall, how would rate the services provided by the provider?



 
9. Overall, how would rate the services provided by Med-X?



 
10. Is there an employee of either Med-X or our provider that you feel deserves special recognition for their efforts?
 

11. Please feel free to provide us with any comments you may have about Med-X or our providers.
Your name  
Your Email (optional)  


Thank you for your time!
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