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Add question		If we have any questions regarding the feedback which you provided us would you feel comfortable with us contacting you? Yes No \| Report abuse	▼
Add question	Remove question	Please rate the value of the service you received during this visit: Excellent – a great value for the money spent Good Fair Poor \| Report abuse	▼
Add question		Did you experience unacceptable wait time in any of these areas? At check-in / reception In the exam room At check-out No, the wait time was what I expected or better \| Report abuse	▼
Add question		Please rate how well the doctor and staff answered your questions and concerns: Excellent Good Fair Poor \| Report abuse	▼
Add question		If you were the manager of our hospital, what would you change to improve the level of patient care and customer service that is currently being provided? \| Report abuse	▼
Add question		How long did you have to wait during your visit? Less than I expected. About what I expected. Longer than I expected. Too long. \| Report abuse	▼
Add question		Was your wait time after checking-in with the receptionist: Less than I expected. About what I expected. Longer than I expected. Too long. \| Report abuse	▼
Add question		When you called for your appointment, was the phone answered courteously? Yes, extremely. Yes, somewhat. No, rudely. I didn't call for an appointment. \| Report abuse	▼
Add question		Were you greeted promptly and courteously when you entered the reception area? Yes, almost immediately. Yes, after a short wait. No, I waited a while. No, I waited too long. \| Report abuse	▼
Add question		Please rate the quality of the medical care your pet received during this visit: Excellent Good Fair Poor \| Report abuse	▼
Add question		Please rate how well the doctor and staff answered your questions and concerns: Excellent Good Fair Poor \| Report abuse	▼
Add question		Was the hospital clean? Very clean. Clean. Somewhat clean. Dirty. Very dirty. \| Report abuse	▼
Add question		How long did you have to wait in the exam room to be seen by the doctor? Less than 10 minutes. 10-20 minutes. 20-30 minutes. Longer than 30 minutes. \| Report abuse	▼
Add question		When you called for your appointment, was the phone answered promptly? Yes, almost immediately. Yes, after a couple of rings. No, it rang for a while. No, I had to hang up and call again later. I didn't call for an appointment. \| Report abuse	▼
Add question		Please rate the value of the service you received during this visit: Excellent - a great value for the money spent Good Fair Poor \| Report abuse	▼
Add question		How do you feel about the fees that were charged for your pet's medical care? Less than I expected. About what I expected. More than I expected. Too much. \| Report abuse	▼
Add question		Were you surprised by any fees that were charged for your pet's medical care? No. Somewhat. Yes. Extremely. \| Report abuse	▼
Add question		Was your wait time to be checked-out by the receptionist: Less than I expected. About what I expected. Longer than I expected. Too long. \| Report abuse	▼
Add question		Was your pet ready to be picked-up at the time you were told? Yes. No. Not applicable. \| Report abuse	▼
Add question		How long did you have to wait to check-out with the receptionist after the visit was completed? Less than 10 minutes. 10-20 minutes. 20-30 minutes. Longer than 30 minutes. \| Report abuse	▼
Add question		Based on your experience, how likely is it that you will return to our hospital for your future needs? Definitely will. Very likely. Likely. Somewhat likely. I wouldn't. \| Report abuse	▼
Add question		Based on your experience, how likely would you be to refer a friend to our hospital? Definitely will. Very likely. Likely. Somewhat likely. I wouldn't. \| Report abuse	▼
Add question		Overall, how would you rate the medical care and/or service you received today at our animal hospital? Excellent Good Average Less than Average Poor \| Report abuse	▼
Add question		Was the waiting room/reception area clean? Very clean. Clean. Somewhat clean. Dirty. Very dirty. \| Report abuse	▼
Add question		Your comments and suggestions are extremely important to us! Please take a moment to give us your feedback. Thank You. \| Report abuse	▼
Add question		How likely would you be to refer a friend to our veterinary hospital? <br />( 5 = "extremely likely" , 1 = "not at all likely" ) 5 4 3 2 1 \| Report abuse	▼
Add question		Please rate your overall wait time during this visit: less than you expected. about what you expected. longer than you expected. unacceptable! \| Report abuse	▼
Add question	Remove question	Microchipping your pet substantially increases the likelihood of a pet returning home by offering secure, reliable, unique and permanent identification. Are you interested in getting your pet Microchiped? Yes \| Report abuse	▼
Add question		How likely are you to recommend us to your friends? 10 - Very likely 9 8 7 6 5 - Somewhat likely 4 3 2 1 - I will not recommend you \| Report abuse	▼
Add question		How did you hear about us? Facebook Drove by / Marquee Internet Search Phone Directory Other \| Report abuse	▼
Add question		What best represents the vocalizations of a fox? Ring-ding-ding-ding-dingeringeding Wa-pa-pa-pa-pa-pa-pow Hatee-hatee-hatee-ho Jacha-chacha-chacha-chow! \| Report abuse	▼
Add question		Testing \| Report abuse	▼
Add question		What Time is it? 5pm 4pm oppa gangnam time NA \| Report abuse	▼
Add question		Do you like our staff? yes no \| Report abuse	▼
Add question		How likely are you to promote us to your friends? \| Report abuse	▼
Add question	Remove question	How likely are you to promote us to your friends? 10 - Very Likely 9 8 7 6 5 - I'm not sure 4 3 2 1 - I would not promote you \| Report abuse	▼
Add question		This is test for testimonials! \| Report abuse	▼
Add question		You're actually going through with this and filling it out? Seriously, you don't need to. This is a test used for development purposes. Your participation will be neither documented nor acknowledged. Still determined? Very well then. \| Report abuse	▼
Add question		How do you feel Free Alive Hungry Happy \| Report abuse	▼
Add question		How did we do today? Great! Okay Not so good Terrible \| Report abuse	▼
Add question		Do you feel comfortable with discharge instructions for post op care? \| Report abuse	▼
Add question		How did you hear about us? Search Engine (Google, Yahoo, Bing, etc.) Facebook Email An online map (Like Google Maps) I got a mailer I saw a sign/billboard I saw your facility Something else not listed here \| Report abuse	▼
Add question		Please tell us how we're doing. And please don't be shy! We need to hear the <strong>good and the bad</strong> so that we can provide you and your pet the best care and experience. :) \| Report abuse	▼
Add question	Remove question	Do you feel comfortable with discharge instructions for post op care? \| Report abuse	▼
Add question		How would you rate your overall experience on your last visit? 5 - Excellent! 4 - Pretty Good 3 - Fine 2 - Not Good 1 - Unacceptable \| Report abuse	▼
Add question		We would LOVE to use your comments publically so that others can hear about your experience. May we post your comments online? Yes No \| Report abuse	▼
Add question		Please tell us how we're doing. And please don't be shy! We need to hear the <strong>good and the bad</strong> so that we can provide you and your pet the best care and experience. :) \| Report abuse	▼
Add question		What Color is the Sky? Blue Pink White \| Report abuse	▼
Add question		Overall experience?? \| Report abuse	▼
Add question		testing ing ing \| Report abuse	▼
Add question		TESTIMONIAL COMMENT EXAMPLE \| Report abuse	▼
Add question		Were your questions answered to your satisfaction by the receptionist? Yes. Mostly. Somewhat. Not at all. \| Report abuse	▼
Add question		Were your questions answered to your satisfaction by the technician/assistant? Yes. Mostly. Somewhat. Not at all. \| Report abuse	▼
Add question		Were your questions answered to your satisfaction by the doctor? Yes. Mostly. Somewhat. Not at all. \| Report abuse	▼
Add question		Were your questions answered to your satisfaction? Yes. Mostly. Somewhat. Not at all. \| Report abuse	▼
Add question		During your visit, were you asked if you needed a refill on Topical Flea Control? Yes No \| Report abuse	▼
Add question		Pet insurance can pay for a significant portion of your pet's health care. Would you like us to email you additional information on pet insurance following the survey? Yes No \| Report abuse	▼
Add question		Microchips are commonly used to help recover lost pets. Would you be interested in having your pet microchipped in the future? Yes I would like more information on my next visit. No \| Report abuse	▼

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