Client Satisfaction Survey General Patient InformationHow would you rate our concern for you & your pet’s privacy?OutstandingGoodAdequateNeeds ImprovementPoorN/AHow often have you visited our practice within the past year?First Visit2-5 VisitsMore than 6Scheduling Your AppointmentDid you schedule an appointment by phone or did you drop in?Scheduled by PhoneScheduled OnlineDrop InIf you scheduled an appointment, did you have to wait longer than expected?NoYesHow easy was it to make an appointment by telephone?Very EasyEasyDifficultVery DifficultN/AHow easy was it to make an appointment online?Very EasyEasyDifficultVery DifficultN/AWas the person who scheduled your appointment courteous and helpful?Very CourteousCourteousIndifferentRudeN/ADay of Your AppointmentHow would you rate the courtesy of the staff at the reception desk?Very CourteousCourteousIndifferentRudeN/AHow long did you wait in the reception area beyond your scheduled appointment time?0-5 Minutes5-20 Minutes20-40 MinutesMore than 40 MinutesHow long did you wait in the exam room before the veterinarian appeared?0-5 Minutes5-20 MInutes20-40 MinutesMore than 40 MinutesThe Medical Support StaffDid the support staff member clearly identify themselves & their qualifications?YesNoHow would you rate the competence of the technician/assistant who helped you?OutstandingGoodAdequateNeeds ImprovementN/AHow would you characterize the concern that the technician/assistant showed?OutstandingGoodAdequateNeeds ImprovementN/ADid the technician/assistant respond to your requests within a reasonable period?YesNoHow would you rate the professionalism and competence of the technician/assistant?OutstandingGoodAdequateNeeds ImprovementN/AThe DoctorWere you able to see the veterinarian of your choice?YesNoDid you feel that your veterinarian spent an adequate amount of time with you?YesNoWhat would describe the demeanor of your veterinarian?Attentive/ConcernedDistractedRushed/InconsiderateHow would you rate the competence of your veterinarian?OutstandingGoodAdequateNeeds ImprovementPoorN/ADid you feel that your veterinarian’s examination was thorough?YesNoHow do you feel about the clarity of the veterinarian’s explanation of your pet’s condition & treatment options?OutstandingGoodAdequateNeeds ImprovementPoorN/AHow well did your veterinarian include you in healthcare decisions?OutstandingGoodAdequateNeeds ImprovementPoorN/AWere your questions answered to your satisfaction?YesNoWould you recommend this facility and its staff to your family and friends?YesNoAdditional 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.
