Feedback Survey

General Patient Information

How often have you visited our practice within the past year?

First Visit2-5 VisitsMore than 6

If this is your first visit, how did you find out about us?

Search EngineFacebookStreet SignYellow PagesReferralOtherNot Applicable

Scheduling Your Appointment

How easy was it to make an appointment by telephone?

Very EasyEasyDifficultVery DifficultN/A

If you scheduled an appointment, did you have to wait longer than expected?

NoYes

Was the person who scheduled your appointment courteous and helpful?

Very CourteousCourteousIndifferentRudeN/A

Day of Your Appointment

How would you rate the courtesy of the staff at the reception desk?

Very CourteousCourteousIndifferentRudeN/A

How long did you wait in the reception area beyond your scheduled appointment time?

0-5 Minutes5-20 Minutes20-40 MinutesMore than 40 Minutes

How long did you wait in the exam room before the veterinarian appeared?

0-5 Minutes5-20 Minutes20-40 MinutesMore than 40 Minutes

The Medical Support Staff

Did the support staff member clearly identify themselves?

YesNo

How would you characterize the concern that the technician/assistant showed?

OutstandingGoodAdequateNeeds improvementPoorN/A

How would you rate the professionalism and competence of the technician/assistant?

OutstandingGoodAdequateNeeds improvementPoorN/A

The Doctor

Were you able to see the veterinarian of your choice?

YesNo

Did you feel that your veterinarian spent an adequate amount of time with you?

YesNo

How would you characterize the concern that the veteriarian showed?

OutstandingGoodAdequateNeeds improvementPoorN/A

How would you rate the competence of your veterinarian?

OutstandingGoodAdequateNeeds improvementPoorN/A

Did you feel that your veterinarian’s examination was thorough?

YesNo

How do you feel about the clarity of the veterinarian’s explanation of your pet’s condition & treatment options?

OutstandingGoodAdequateNeeds improvementPoorN/A

How well did your veterinarian include you in healthcare decisions?

OutstandingGoodAdequateNeeds improvementPoorN/A

Were your questions answered to your satisfaction?

YesNo

Would you recommend this facility and its staff to your family and friends?

YesNo

Additional Feedback

Please list any areas in which our service could be improved...

Please share any additional comments...