Wheelchair Assistance Feedback Survey
Please share your feedback regarding your recent wheelchair assistance experience. Your input helps us improve our services.
Full Name
*
First Name
Last Name
Contact Email (optional)
example@example.com
Date of Service
*
-
Month
-
Day
Year
Date
Location of Assistance (e.g., terminal, department, gate)
*
Please rate your overall satisfaction with the wheelchair assistance you received.
*
1
2
3
4
5
How would you rate the professionalism and courtesy of the staff?
*
1
2
3
4
5
Please indicate your level of agreement with the following statements about the assistance you received.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The staff arrived promptly
1
2
3
4
5
The wheelchair/equipment was clean and in good condition
6
7
8
9
10
The process was easy to understand
11
12
13
14
15
I felt safe and comfortable during the assistance
16
17
18
19
20
Which part of the wheelchair assistance process could be improved? (Select all that apply)
Waiting time
Staff communication
Equipment condition
Ease of requesting assistance
Other
How did you request wheelchair assistance?
*
In advance (online or by phone)
At the location (walk-in)
Through a third party (family, staff, etc.)
Other
Would you like to be contacted for follow-up regarding your feedback?
Yes, please contact me.
No, I do not wish to be contacted.
Additional comments or suggestions
Submit Feedback
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