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

Was it easy to make an appointment?  Yes No

Are our office hours convenient to you?  Yes No

 Was the receptionist helpful and polite?  Yes No

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

Did our receptionists smile and greet you promptly?  Yes No

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...

Did the exam room assistant smile and greet you?  Yes No

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...

Greeted me and my pet?  Yes No

Introduced him/herself?  Yes No

Were polite and friendly?  Yes No

Verified the reason for my visit?  Yes No

Had good bedside manners?  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 off to make you and your pet's day a little better?