Client Questionnaire About the ClinicHow were you referred to our office? Friend Neighbor Drove By Yellow Pages Our parking lot/grounds: Adequate parking Inadequate parking Clean Littered or unkempt Our waiting room was: Comfortable Neat and clean Uncomfortable Disorderly Odor-free Needed odor control Child-friendly Our office hours are: Convenient Restrictive Should be open more About the StaffOur receptionist(s): Stood and greeted you Were warm and cheerful Were cold or unfriendly Gave their undivided attention Seemed indifferent Were hospitable When you telephoned: Your call was answered promptly There was a long wait for someone to answer You had trouble getting through You were placed on hold too long (Did not phone) Your phone conversation was: Courteous Hurried Impolite Informative Preoccupied Our technician: Greeted you warmly Was gentle with your pet Seemed proficient Was knowledgeable Was a poor communicator About the VeterinarianThe veterinarian: Introduced him/herself with a warm greeting Listened well to my pet's present symptoms Did not seem interested in what I had to say Seemed in a hurry Described the diagnosis and treatment well Left me confused about how to treat my pet The veterinarian was: Professional in manner and appearance Acceptable in manner and appearance Inferior in manner and appearance Good at comforting me and my pet Insensitive in his/her use of people skills About Your ExperienceWas your waiting time reasonable? Yes No Please discuss below:Did you understand our fees? Yes No Please discuss below:Do you feel the fees were reasonable? Yes No Please discuss below:Other CommentsWhy did you choose this hospital?Have you recommended us to others? Yes No Why 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' names Approximate date of your last visit MM slash DD slash YYYY May we call you to follow up with any concerns? Yes No NameThis field is for validation purposes and should be left unchanged.
