Feedback Survey

We welcome your feedback and your answers will be kept confidential. Please take a few minutes to fill out this survey on the timeliness and quality of the service you receive from our practice. Thank you for your participation.

General Patient Information

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

 First Visit 2-5 Visits More than 6

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

 Search Engine Facebook Street Sign Yellow Pages Referral Other Not Applicable

Scheduling Your Appointment

How easy was it to make an appointment by telephone?

 Very Easy Easy Difficult Very Difficult N/A

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

 No Yes

Was the person who scheduled your appointment courteous and helpful?

 Very Courteous Courteous Indifferent Rude N/A

Day of Your Appointment

If a farm call, did you get adequate notice of the veterinarian’s arrival?

 Yes No

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

 Very Courteous Courteous Indifferent Rude N/A

How long did you wait in the stall area before the veterinarian appeared?

 0-5 Minutes 5-20 Minutes 20-40 Minutes More than 40 Minutes

The Medical Support Staff

If your Veterinarian was assisted by a technician/assistant did they clearly identify themselves?

 Yes No

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

 Outstanding Good Adequate Needs improvement Poor N/A

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

 Outstanding Good Adequate Needs improvement Poor N/A

The Doctor

Were you able to see the veterinarian of your choice?

 Yes No

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

 Yes No

How would you characterize the concern that the veteriarian showed?

 Outstanding Good Adequate Needs improvement Poor N/A

How would you rate the competence of your veterinarian?

 Outstanding Good Adequate Needs improvement Poor N/A

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

 Yes No

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

 Outstanding Good Adequate Needs improvement Poor N/A

How well did your veterinarian include you in healthcare decisions?

 Outstanding Good Adequate Needs improvement Poor N/A

Were your questions answered to your satisfaction?

 Yes No

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

 Yes No

Additional Feedback

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

Please share any additional comments…

Check to confirm submission.