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 then 6

Scheduling Your Appointment

Was the person who scheduled your appointment courteous and helpful?

 Very Courteous Courteous Indifferent Rude N/A

Day of Your Appointment

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 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?

 0-5 Minutes 5-20 Minutes 20-40 Minutes More then 40 Minutes

The Medical Support Staff

Did the support staff member clearly identify themselves & their qualifications?

 Yes No

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

 Outstanding Good Adequate Needs improvement Poor N/A

Did the technician/assistant respond to your requests within a reasonable period?

 Yes No

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

 Outstanding Good Adequate Needs improvement Poor N/A

The Doctor

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

 Yes No

What would describe the demeanor of your veterinarian?

 Attentive Concerned Distracted Rushed Inconsiderate

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 pet’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…


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