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CLIENT SURVEY |
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Thank you for placing
your pet’s health concerns in our hands. We
value your trust and our two main goals are to provide the best care possible for your
pet and to make your visit an enjoyable one with friendly service.
However, we need your help to make sure that we are meeting or exceeding
your needs and expectations.
Please take a few
minutes to complete our online survey so that we may constantly improve our services for you and
your pets. Your feedback is the only
way we can find out about things we are doing well (we all need a pat on
the back every now and then) and things we didn't do so well (how can we
fix the problem if good people like you don't let us know that we have a
problem?!). So whether you had an awesome experience with us or an
experience that did not meet your expectations, please let us know.
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Your Information |
| First Name, Last
Name |
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| Telephone Number |
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| One of your pets'
names |
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| Approximate date
of your last visit |
Use this format: 01/01/07 |
| May
we call you back to follow up with any of your concerns? |
Yes
No |
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The Reception Area |
| Comfortable |
Yes
No |
| Neat
and clean |
Yes
No |
| Odor-free |
Yes
No |
| Did
you watch any of the education material on our television? |
Yes
No
What
TV? |
|
When I telephoned |
| My
call was answered promptly |
Yes
No |
| It
was easy to make an appointment |
Yes
No |
| I
received a convenient appointment |
Yes
No |
| The
Receptionist answered all of my questions |
Yes
No |
| The
Receptionist was polite |
Yes
No |
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When
I visited the practice, The Receptionist |
| Smiled
and greeted me |
Yes
No |
| Was
polite and friendly |
Yes
No |
| Verified
my name, my pet's name and why I was here |
Yes
No |
| Informed
me if the doctor was way behind schedule |
Yes
No
Did
not apply |
| Went
over the invoice with me and gave me a receipt |
Yes
No |
| Offered
to help me carry food or help with my pet out to my car (if needed) |
Yes
No
Did
not apply |
| On a scale of 1-5
with 1 being poor, 3 being average and 5 being excellent, how
would you rate our receptionists? |
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| If
you answered something other than 4 or 5, please let us know what went
wrong: |
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The
Exam Room Assistant |
| Smiled
and greeted me |
Yes
No |
| Was
polite and friendly |
Yes
No |
| Verified
why I came in and the services desired |
Yes
No |
| Answered
any questions I had |
Yes
No |
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On
a scale of 1-5 with 1 being poor, 3 being average and 5 being
excellent, how would you rate your experience with the Exam
Room Assistant? |
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| If
you answered something other than 4 or 5, please let us know what went
wrong: |
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The Doctor |
| Who did you see? |
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| Smiled
and greeted me |
Yes
No |
| Was
polite and friendly |
Yes
No |
| Verified
why I came in and the services desired |
Yes
No |
| Has
a good bedside manner |
Yes
No |
| Explained
the physical examination clearly |
Yes
No
Exam
not performed |
| Discussed
any problem areas in detail |
Yes
No |
| Answered
any questions I had |
Yes
No |
| Discussed
my pet's Report Card with me (or an Exam Room Assistant did) |
Yes
No
What
is a Report Card? |
| Provided
a Summary of Treatment Recommendations (Estimate) for a recommended surgery/dental or
other recommended medical treatment |
Yes
No
Did
not apply |
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On
a scale of 1-5 with 1 being poor, 3 being average and 5 being
excellent, how would you rate your experience with
your Doctor? |
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| If
you answered something other than 4 or 5, please let us know what went
wrong: |
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Your Time |
| We
value your time. One of our main goals is to work as quickly as
possible while giving each of our clients the full attention they
deserve. Due to the nature of healthcare (emergencies, traffic causing
clients not to arrive on time, unexpected problems discovered during
examination, etc...), most delays are beyond our control. But, we want you to
be happy and for your wait to be reasonable. What did you
experience during your visit?
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| Amount
of time before a Receptionist acknowledged me and checked me in |
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| Time
waited until I first saw an Exam Room Assistant |
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| Time
waited until I first saw the Doctor |
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| Length
of visit with Doctor in exam room |
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| Time
waited after Doctor finished until check-out |
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| Time
it took to pay and go over invoice (check-out) |
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| Is
there anyone at our hospital who provided you with exceptionally good
OR really poor service? If so, please give us a little information so
we can pat them on the back or kick them in the pants! |
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| Would
you recommend our hospital to others? |
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| Were
you satisfied with the value of services received during your visit? |
Yes
No |
| On
a scale of 1-5 with 1 being poor, 3 being average and 5 being
excellent, what is your
overall opinion of Claws & Paws Veterinary Hospital®?: |
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| Other
comments and is there anything we can do to improve your next visit: |
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| Please be sure to hit
the Submit button below (just once) to send us the form. Thank you for
your time and interest in helping us improve your veterinary hospital! |
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