Bregman Veterinary Group Client Satisfaction Survey
Date of Visit
/
Month
/
Day
Year
Full Name
First Name
Last Name
E-mail Address
Pet's Name
Which Hospital Did you Visit
Fifth Avenue Cat Clinic, LLP (Park Slope)
Midbrook Animal Hospital (Midwood Brooklyn)
Paws and Claws Veterinary Hospital (Williamsburg)
The Cat Hospital, LLP (Williston Park, Long Island)
Doctor Seen
Jack Bregman, VMD
Eric Bregman, VMD
Allan Bregman, DVM
Robin Sturtz, DVM
Anjali Pingle, MVB
Suzanne Zelman, DVM
Kimberly Levine, DVM
Mark Landesman
Do not recall Dr's Name
How would you rate your initial telephone contact with the hospital .
1
2
3
4
5
Worst
Best
Were you able to schedule an appointment time that was convenient for you
Yes
No
Who Greeted you when you arrived
Receptionist
Nurse/Technician
Doctor
Staff Member, not sure of position
How long did you wait before you and your pet were seen by a doctor
I was seen very quickly
I waited a reasonable amount of time
I waited too long
How would you rate the cleanliness and comfort of our facility
1
2
3
4
5
Worst
Best
How would you rate the cleanliness and comfort of our examination room
1
2
3
4
5
Worst
Best
Was your pet's examination thorough and to your satisfaction
Yes
No
The doctor explained the tests and recommendations in a manner you were able to understand
1
2
3
4
5
Worst
Best
If your pet was admitted to the hospital, were you given an estimate for the goods and services to be performed
Yes
No
How would you rate the quality of care your pet received at our facility
Excellent
Good
Fair
Poor
Please Provide an additional comments or suggestions
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