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This form is intended for use by Healthcare Facilities in and around the Hawke's Bay region of New Zealand.
Questionnaire
Inter-facility and non-emergency patient transport
Questionnaire - 10 questions
File Size:
900 kb
File Type:
pdf
Download File
Please fill in the form below and then press submit (or download the pdf to the right, fill in and return via email).
We appreciate your help
*
Indicates required field
Facility Name (required)
*
Email (not required)
*
What is the approximate number of residents at your facility?
*
less than 10
more than 10 but less than 20
more than 20 but less than 40
more than 40
Does your facility currently use a Patient Transport/Transfer service?
*
Yes
No
If yes, do you require patients to be transported by ambulance, mobility vehicle or car? (Mark any that are appropriate)
*
Ambulance
Mobility Vehicle
Car
How often would you require each service?
Ambulance (number of times per week)
*
Mobility Vehicle (number of times per week)
*
Car (number of times per week)
*
Is there a need for a healthcare professional to monitor these patients en-route?
*
Yes
No
Do you prefer to supply this member of staff or would you prefer the PTS provider to supply them?
*
Own staff member
PTS Provider
Do you require Paramedical Services on critical care patient transports? (eg ILS Paramedics, Intensive Care Paramedics)
*
Yes
No
Who is your current provider of non-emergency patient transport?
*
Are you currently in an exclusive contract for this service?
*
Yes
No
Would you be open to contracting a local, private non-emergency patient transport service in the future?
*
Yes
No
Additional Comments
*
Please feel free to add any feedback you may wish, including specific requirements
Submit
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Home
Event Paramedics
Booking form : event medics
First Aid Training
Our First Aid Courses
Basic First Aid Courses
>
Basic First Aid - 4 or 8 hour
Refresher First Aid Course
CPR and AED courses
Comprehensive First Aid Courses
>
Workplace First Aid Course
Comprehensive First Aid Course
Advanced First Aid Courses
>
Advanced First Aid Course
booking form : Training
First Aid store
First Aid Kits
Consumables
Contact Us
The MOS Charity
FAQs
Personnel login
Blog