Thank you for giving us the opportunity to serve you and your pet.  Ultimate customer service and satisfaction is our #1 goal.  You can help us better provide for you and your pet's needs by sharing your comments with us.  By completing this questionnaire, you can take part in our staff training meetings and be assured that your comments will be discussed and acted upon.  Thank you!

Form - Client Satisfaction Survey

The receptionist was knowledgeable and courteous when I called.
1 (Very poor)
2
3
4
5 (Excellent)

What is the name of the person who you spoke with on the phone?

Were the parking lot / grounds clean?
1 (Very poor)
2
3
4
5 (Excellent)

The hospital was clean, odor free, safe and professional in appearance.
1 (Very poor)
2
3
4
5 (Excellent)

Were you greeted promptly by a friendly team member?
1 (Very poor)
2
3
4
5 (Excellent)

My appointment was seen on time, or at least within an acceptable time.
1 (Very poor)
2
3
4
5 (Excellent)

The nurse was warm, gentle, proficient, knowledgeable and communicated well.
1 (Very poor)
2
3
4
5 (Excellent)

Who was your nurse?

The doctor listened, explained well, did a thorough exam, and was professional and compassionate.
1 (Very poor)
2
3
4
5 (Excellent)

Who was your doctor?

Were the fees reasonable and explained well?
1 (Very poor)
2
3
4
5 (Excellent)

How likely are you to recommend 43rd Ave. Animal Hospital to others?
1 (Not likely)
2
3
4
5 (Most likely)

If you would not recommend us, please explain why.

What services or products would you like to see us offer in the future?

Please share any comments that you feel would help us understand why you rated us as you did.

Name (optional)
First Name
Last Name
E-Mail Address (optional) :

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