The study analyses the influence of perceived service quality and patients' satisfaction on behavioral intentions, as well as the role of the institutional image in this chain of relations, studying also the applicability of the PAKSERV scale in the Cape Verdean health care context. Data collection was conducted through a self-administered questionnaire applied to emergency services users in two public hospitals in Cape Verde. Results of a structural equation modelling approach confirm the influence of perceived service quality and patients' satisfaction on behavioral intentions, as well as a partial mediation role of the institutional image. Findings also suggest the applicability of the PAKSERV scale in the context explored. This research contributes to the development of service management theory, first, testing the PAKSERV scale both in a different geographical context (Cape Verde), and in a different sectorial context (public hospitals), and second, analyzing the influence of service quality and users' satisfaction on behavioral intentions in the context of emergency services in Cape Verde's public hospitals.