How Were You Referred To Our Office?
" Friend
" Drove By
" Website
" Yellow Pages
" Other (Please specify) ______________________________________

Our Parking Lot/Grounds:
" Adequate parking
" Inadequate parking
" Clean
" Littered or unkempt

Our Waiting Room Was:
" Comfortable
" Neat and clean
" Uncomfortable
" Disorderly
" Odor-free
" Needed odor control
" Child-friendly

Our Office Hours Are:
" Convenient
" Restrictive
" Should be open more
" I would use later hours (please specify) _________________________________________________

Our Receptionist(s):
" Stood and greeted you
" Were warm and cheerful
" Were cold or unfriendly
" Gave their undivided attention
" Seemed indifferent
" Were hospitable

When You Telephoned:
" Your call was answered promptly
" There was a long wait for someone to answer
" You had trouble getting through
" You were placed on hold too long

Your Phone Conversation Was:
" Courteous
" Hurried
" Impolite
" Informative
" Preoccupied
" I did not phone

Our Technician:
" Greeted you warmly
" Was gentle with your pet
" Seemed proficient
" Was knowledgeable
" Was a poor communicator

The Veterinarian:
" Introduced him/herself with a warm greeting
" Listened well to my pet's present symptoms
" Did not seem interested in what I had to say
" Seemed in a hurry
" Described the diagnosis and treatment well
" Left me confused about how to treat my pet

The Veterinarian Was:
" Professional in manner and appearance
" Acceptable in manner and appearance
" Inferior in manner and appearance
" Good at comforting me and my pet
" Able to make me feel like a friend
" Insensitive in his/her use of people skills

Was your waiting time reasonable?
" Yes " No

Did you understand our fees? Do you feel the fees were reasonable?
" Yes " No " Yes " No

If you checked "no" to any of the above questions, please discuss below:
_____________________________________________________

Why did you choose this hospital?
_____________________________________________________

Have you recommended us to others?
" Yes " No

If so, why? (If not, why not?)
_____________________________________________________

Was there anyone at the Animal Clinic & Hospital that provided you with exceptionally good or poor service?
_____________________________________________________

If you were our practice manager, what suggestions would you have for improving the office, staff or procedures?
_____________________________________________________