Name (optional):

Telephone Number (optional):

Pet's Name: Date of Visit:

May we contact you with any concerns? Yes No

Was our reception area...   Comfortable? Yes No      Neat and Clean? Yes No     Odor-Free?  Yes No

When you telephoned...

Was your call answered promptly?  Yes No

Are our office hours convenient to you?  Yes No

Were you kept on hold for more than 2 minutes?  Yes No N/A

Were our receptionist polite and friendly?  Yes No

On a scale from 1-5 (1 being poor and 5 being excellent) how would you rate our receptionists?  1-Poor 2-Fair 3-Just ok 4-Good 5-Excellent!

Comments: 

In the Exam Room...

Was the exam room assistant polite and friendly?  Yes No

Was the exam room assistant helpful and knowledgeable?  Yes No

Did the exam room assistant follow through with my requests (ie. estimates, information, etc.)  Yes No

On a scale from 1-5 (1 being poor and 5 being excellent) how would you rate your exam room assistant?   1-Poor 2-Fair 3-Just Ok 4-Good 5-Excellent!

Comments:

Our doctors...

Were polite and friendly?  Yes No

Discussed any problems?  Yes No

Spent enough time answering my questions?  Yes No

My doctor was...  Dr. Donna McWilliams Dr. Mark Downing

Are there any additional services that we could offer to make you and your pet's day a little better?