Client Satisfaction Questionnaire

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Client Satisfaction Questionnaire
We would love to hear from you about your recent visit to our Hospital! Please fill out this form and we will enter you into a draw for a free bag of food!

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.

 












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