General Patient InformationWhich department did you see?Anesthesia & Pain ManagementCardiologyDiagnostic Imaging/RadiologyEmergency/CriticalInternal MedicineNeurologyOncologyOphthalmologyRehabilitationSurgeryWhich doctor did you see?How would you rate our concern for you & your pet’s privacy? Outstanding Good Adequate Needs Improvement Poor N/AHow often have you visited our practice within the past year? First Visit 2-5 Visits More than 6Day of Your AppointmentHow would you rate the courtesy of the staff at the reception desk? Very Courteous Courteous Indifferent Rude N/AHow long did you wait in the reception area beyond your scheduled appointment time? 0-5 Minutes 5-20 Minutes 20-40 Minutes More than 40 MinutesHow long did you wait in the exam room before the veterinarian appeared? 0-5 Minutes 5-20 MInutes 20-40 Minutes More than 40 MinutesThe Medical Support StaffDid the support staff member clearly identify themselves & their qualifications? Yes NoHow would you rate the competence of the technician/assistant who helped you? Outstanding Good Adequate Needs Improvement N/AHow would you characterize the concern that the technician/assistant showed? Outstanding Good Adequate Needs Improvement N/ADid the technician/assistant respond to your requests within a reasonable period? Yes NoHow would you rate the professionalism and competence of the technician/assistant? Outstanding Good Adequate Needs Improvement N/AThe DoctorWere you able to see the veterinarian of your choice? Yes NoDid you feel that your veterinarian spent an adequate amount of time with you? Yes NoWhat would describe the demeanor of your veterinarian? Attentive/Concerned Distracted Rushed/InconsiderateHow would you rate the competence of your veterinarian? Outstanding Good Adequate Needs Improvement Poor N/ADid you feel that your veterinarian’s examination was thorough? Yes NoHow do you feel about the clarity of the veterinarian’s explanation of your pet’s condition & treatment options? Outstanding Good Adequate Needs Improvement Poor N/AHow well did your veterinarian include you in healthcare decisions? Outstanding Good Adequate Needs Improvement Poor N/AWere your questions answered to your satisfaction? Yes NoWould you recommend this facility and its staff to your family and friends? Yes NoAdditional FeedbackPlease list any areas in which our service could be improved…Please share any additional comments…Please share your name if you choose...PhoneThis field is for validation purposes and should be left unchanged.
