Client Questionnaire About the ClinicHow were you referred to our office?FriendNeighborDrove ByYellow PagesOur parking lot/grounds:Adequate parkingInadequate parkingCleanLittered or unkemptOur waiting room was:ComfortableNeat and cleanUncomfortableDisorderlyOdor-freeNeeded odor controlChild-friendlyOur office hours are:ConvenientRestrictiveShould be open moreAbout the StaffOur receptionist(s):Stood and greeted youWere warm and cheerfulWere cold or unfriendlyGave their undivided attentionSeemed indifferentWere hospitableWhen you telephoned:Your call was answered promptlyThere was a long wait for someone to answerYou had trouble getting throughYou were placed on hold too long(Did not phone)Your phone conversation was:CourteousHurriedImpoliteInformativePreoccupiedOur technician:Greeted you warmlyWas gentle with your petSeemed proficientWas knowledgeableWas a poor communicatorAbout the VeterinarianThe veterinarian:Introduced him/herself with a warm greetingListened well to my pet's present symptomsDid not seem interested in what I had to saySeemed in a hurryDescribed the diagnosis and treatment wellLeft me confused about how to treat my petThe veterinarian was:Professional in manner and appearanceAcceptable in manner and appearanceInferior in manner and appearanceGood at comforting me and my petInsensitive in his/her use of people skillsAbout Your ExperienceWas your waiting time reasonable?YesNoPlease discuss below:Did you understand our fees?YesNoPlease discuss below:Do you feel the fees were reasonable?YesNoPlease discuss below:Other CommentsWhy did you choose this hospital?Have you recommended us to others?YesNoWhy or why not?If you were our practice manager, what suggestions would you have for improving the office, staff or procedures?Your Information (optional)Name PhoneOne of your pets' namesApproximate date of your last visit Date Format: MM slash DD slash YYYY May we call you to follow up with any concerns?YesNoEmailThis field is for validation purposes and should be left unchanged.
