How would you rate our concern for you & your pet’s privacy?
Outstanding Good Adequate Needs improvement Poor N/A
How often have you visited our practice within the past year?
First Visit 2-5 Visits More then 6
Did you schedule an appointment by phone or did you drop in?
Scheduled by Phone Scheduled Online Drop In
If you scheduled an appointment, did you have to wait longer than expected?
No Yes
How easy was it to make an appointment by telephone?
Very Easy Easy Difficult Very Difficult N/A
How easy was it to make an appointment online?
Was the person who scheduled your appointment courteous and helpful?
Very Courteous Courteous Indifferent Rude N/A
How would you rate the courtesy of the staff at the reception desk?
How long did you wait in the reception area beyond your scheduled appointment time?
0-5 Minutes 5-20 Minutes 20-40 Minutes More then 40 Minutes
How long did you wait in the exam room before the veterinarian appeared?
Did the support staff member clearly identify themselves & their qualifications?
Yes No
How would you rate the competence of the technician/assistant who helped you?
How would you characterize the concern that the technician/assistant showed?
Did the technician/assistant respond to your requests within a reasonable period?
How would you rate the professionalism and competence of the technician/assistant?
Were you able to see the veterinarian of your choice?
Did you feel that your veterinarian spent an adequate amount of time with you?
What would describe the demeanor of your veterinarian?
Attentive Concerned Distracted Rushed Inconsiderate
How would you rate the competence of your veterinarian?
Did you feel that your veterinarian’s examination was thorough?
How do you feel about the clarity of the veterinarian’s explanation of your pet’s condition & treatment options?
How well did your veterinarian include you in healthcare decisions?
Were your questions answered to your satisfaction?
Would you recommend this facility and its staff to your family and friends?
Please list any areas in which our service could be improved…
Please share any additional comments…
Other Medications: Which is greater, 9 or 3?
Check to confirm submission.