Client Satisfaction Questionnaire

First Name*

Last Name*

Pet's Name(s)*

Phone Number*

How were you referred to our office?*

Friend
Drove by
Yellowpages
Website
Facebook
Other

What was the reason for your most recent visit to Blackfalds Veterinary Hospital?*

Routine Vaccination Appointment/Checkup
Medical Problem/Illness Appointment
Emergency Visit
To Purchase Food or Medications

Date of most recent visit*

Please rate your experience booking an appointment:

Excellent
Good
Fair
Poor

Please rate your experience checking in:

Excellent
Good
Fair
Poor

Please rate your experience during your pet's examination:

Excellent
Good
Fair
Poor

Please rate the medical/health recommendations made for your pet:

Excellent
Good
Fair
Poor

Please rate your experience during check out:

Excellent
Good
Fair
Poor

Please comment on any fair/poor responses:

Why do you choose to utilize the services at Blackfalds Veterinary Hospital? Check all that apply.

The doctors
The staff
Quality of care
Value for my money
Clean, modern facility
Variety of services/products offered
Convenience
Don't like the other options available
Other

If other, please specify:

Our receptionist(s):

Were warm and friendly
Gave their undivided attention
Were hospitable
Were cold or unfriendly
Seemed indifferent

Comments regarding our Receptionist(s):

Did you receive the level of care you expected?

Yes
No

If no, why not?

Regarding the cost of the services and products that you received, do you feel that:

The cost was what I expected
The cost was more than I expected
The cost was less than I expected

Your Veterinarian was:

Dr. Lisa Loewen
Dr. Lynne Copeland
Dr. Angela Reid
Dr. Tara Dixon
I did not see a Veterinarian at this visit

Your Veterinarian:

Introduced him/herself with a warm greeting
Listened well to my pet's present symptoms
Described the diagnosis and treatment well
Did not seem interested in what I had to say
Seemed in a hurry
Left me confused about how to treat my pet

Comments regarding your Veterinarian:

Have you recommended us to others?

Yes
No

If yes, why? If no, why not?

Was there any part of your visit that was disappointing or negative?

No
Yes

Please explain:

What suggestions would you have for improving the hospital, staff or our procedures?

Blackfalds Veterinary Hospital is dedicated to providing exceptional service and quality care to you and your pet. Please feel free to make any other comments that will allow us to serve you better. Thanks for your time! We appreciate your comments.