Client Satisfaction Survey

Form - Client Satisfaction Survey Form

How did you find us?
How did you find us?
Referal from a friend
Hospital sign
Internet search engine
Our Website
Yellow pages book
Yellow pages online

Other:

When you called our office did you find the person who answered the phone to be.....
Professional?
Yes
No

Friendly?
Yes
No

Courteous?
Yes
No

Informative?
Yes
No

Did the person who answered the phone take enough time to answer all your questions?
Selection
Yes
No

Were you satisfied by the service you received from the person who answered your call?
Selection
Yes
No

When you arrived at our practice...
Did you receive a warm and friendly welcome from our receptionist?
Yes
No

Was your wait?
What you expected
Longer than you expected

Did our receptionist take care of all of your needs?
Yes
No

How could our receptionists provide you with better service?
Suggestions:

When you were brought into an exam room did you find the technician who assisted you to be...
Professional?
Yes
No

Friendly?
Yes
No

Attentive to the reason for your visit?
Yes
No

Did the technician who assisted you...
Ask appropriate questions pertaining to the nature of your visit?
Yes
No

Provide you with answers to your questions?
Yes
No

Treat you and your pet with kindness and respect?
Yes
No

How could our technicians provide you with better service?
Suggestions

Which veterinarian did you see?
Our vets:
Dr. Cinclair
Dr. Pilkington
Dr. Molidor
Dr. Wenaas
Dr. Friend
I prefer not to specify

Was this your first visit with this veterinarian?
Selection
Yes
No

Was the veterinarian you visited....
Professional?
Yes
No

Friendly?
Yes
No

Informative?
Yes
No

Did the attending veterinarian listen to your questions and concerns?
Selection
Yes
No

Did the attending veterinarian answer your questions to your satisfaction?
Selection
Yes
No

Did the attending veterinarian provide you with clear explanations for the care they suggested?
Selection
Yes
No

If you asked about cost, did the attending veterinarian provide an appropriate estimate?
Selection
Yes
No

Would you like to see this veterinarian again?
Selection
Yes
No

How could the attending veterinarian provide you with better service?
Suggestions:

How did you find our fees?
Selection
Appropriate for the service provided
Too high
Surprisingly below what I expected

Would you recommend us to a friend?
Selection
Yes
No

If no, why not?

We welcome any additional suggestions?
Suggestions:

Surveys can be submitted anonymously or you may provide your name if you like.
Name
First Name
Last Name
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