Client Questionnaire

HIDDEN VALLEY ANIMAL HOSPITAL Client Questionnaire

At Hidden Valley Animal Hospital, we care about pets and their people. We wish to provide you with excellent quality veterinary service in a modern, clean and caring environment.

You can help us in providing for you and you pet's needs by sharing your comments with us about your expectations regarding veterinary care. By completing this questionnaire, you can take part in our staff meetings and be assured that your comments will be discussed and acted upon. Thank you very much for your time and your thoughts.

Thank you for using our service. Please share your feedback by filling in the information below.

First Name

Last Name

Address

City

State

Postal Code

Phone

Email Address

How Long Have You Been Using Our Service?

How Were You Referred To Our Office?

Our Parking Lot:

Adequate parking

Inadequate parking

Clean

Littered or unkept

Our Receptionist(s):

When you Telephoned:

Your call was answered promptly

Took a long time to be answered

You had trouble getting through

You were on hold for too long

During Your Phone Conversation, Our Receptionist Was:

Our Waiting Room Was:

In The Exam Room, Our Pet Health Educator:

The Veterinarian

Introduced himself with a warm greeting

Listened well to my pet's present symptoms

Described the diagnosis and treatment well

Seemed in a hurry

Did not seem interested in what I had to say

Left me confused about how to treat my pet

As A Team, The Staff:

Was professional in manner and appearance

Acceptable in manner and appearance

Inferior in manner and appearance

Good at comforting me and my pet

Able to make me feel like a friend

Insensitive and cold

Had poor people skills

Was Your Waiting Time Reasonable?

Yes

No

Please rate the following aspects of our service.

	Excellent	Good	Fair	Mediocre	Very Bad	Not Applicable
Staff Assistance
Staff Competence
Price of Services
Price of Products
Quality of Services
Waiting Time

What do you most like about our service?

What do you least like about our service?

Compared to other services of this type, how would you rate our service?

Overall, how satisfied are you with our service?

How likely are you to continue to use our service?

Would you recommend this service to others?

Yes

No

Indicates Response Required