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If we have any questions regarding the feedback which you provided us would you feel comfortable with us contacting you?
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Please rate the value of the service you received during this visit:
- Excellent – a great value for the money spent
- Good
- Fair
- Poor
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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
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Please rate how well the doctor and staff answered your questions and concerns:
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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?
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How long did you have to wait during your visit?
- Less than I expected.
- About what I expected.
- Longer than I expected.
- Too long.
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Was your wait time after checking-in with the receptionist:
- Less than I expected.
- About what I expected.
- Longer than I expected.
- Too long.
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When you called for your appointment, was the phone answered courteously?
- Yes, extremely.
- Yes, somewhat.
- No, rudely.
- I didn't call for an appointment.
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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.
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Please rate the quality of the medical care your pet received during this visit:
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Please rate how well the doctor and staff answered your questions and concerns:
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Was the hospital clean?
- Very clean.
- Clean.
- Somewhat clean.
- Dirty.
- Very dirty.
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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.
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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.
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Please rate the value of the service you received during this visit:
- Excellent - a great value for the money spent
- Good
- Fair
- Poor
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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.
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Were you surprised by any fees that were charged for your pet's medical care?
- No.
- Somewhat.
- Yes.
- Extremely.
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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.
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Was your pet ready to be picked-up at the time you were told?
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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.
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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.
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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.
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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
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Was the waiting room/reception area clean?
- Very clean.
- Clean.
- Somewhat clean.
- Dirty.
- Very dirty.
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Your comments and suggestions are extremely important to us! Please take a moment to give us your feedback. Thank You.
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How likely would you be to refer a friend to our veterinary hospital? <br />( 5 = "extremely likely" , 1 = "not at all likely" )
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Please rate your overall wait time during this visit:
- less than you expected.
- about what you expected.
- longer than you expected.
- unacceptable!
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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?
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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
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How did you hear about us?
- Facebook
- Drove by / Marquee
- Internet Search
- Phone Directory
- Other
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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!
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Testing
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What Time is it?
- 5pm
- 4pm
- oppa gangnam time
- NA
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Do you like our staff?
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How likely are you to promote us to your friends?
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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
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This is test for testimonials!
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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.
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How do you feel
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How did we do today?
- Great!
- Okay
- Not so good
- Terrible
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Do you feel comfortable with discharge instructions for post op care?
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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
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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. :)
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Do you feel comfortable with discharge instructions for post op care?
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How would you rate your overall experience on your last visit?
- 5 - Excellent!
- 4 - Pretty Good
- 3 - Fine
- 2 - Not Good
- 1 - Unacceptable
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We would LOVE to use your comments publically so that others can hear about your experience. May we post your comments online?
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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. :)
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What Color is the Sky?
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Overall experience??
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testing ing ing
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TESTIMONIAL COMMENT EXAMPLE
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Were your questions answered to your satisfaction by the receptionist?
- Yes.
- Mostly.
- Somewhat.
- Not at all.
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Were your questions answered to your satisfaction by the technician/assistant?
- Yes.
- Mostly.
- Somewhat.
- Not at all.
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Were your questions answered to your satisfaction by the doctor?
- Yes.
- Mostly.
- Somewhat.
- Not at all.
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Were your questions answered to your satisfaction?
- Yes.
- Mostly.
- Somewhat.
- Not at all.
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During your visit, were you asked if you needed a refill on Topical Flea Control?
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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?
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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
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