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Countryside - Client Satisfaction Survey Form
1
Client Information
Name
Phone Number
E-mail
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2
How long have you been bringing your pet(s) to our hospital?
Less than 6 months
6 months to 2 years
More than 2 years
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3
When calling to schedule an appointment, I most often
Get an appointment that fits my schedule
Encounter a busy signal
Am placed on hold
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4
When visiting the hospital, my appointment begins at the scheduled time
Yes
No
Sometimes
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5
The front office staff
Please Select
Yes
No
Sometimes
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Yes
No
Sometimes
Greet me and my pet by name?
Please Select
Yes
No
Sometimes
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Yes
No
Sometimes
Are helpful and courteous?
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6
The front office staff are able to address my concerns and answer all of my questions?
Yes
No
Sometimes
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7
The veterinary technicians and assistants
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Yes
No
Sometimes
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Yes
No
Sometimes
Are kind and careful with my pet(s)
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Yes
No
Sometimes
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Yes
No
Sometimes
Are able to answer my questions?
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Yes
No
Sometimes
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Yes
No
Sometimes
Are friendly and outgoing?
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8
The veterinarian(s)
Please Select
Yes
No
Sometimes
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Yes
No
Sometimes
Is compassionate and courteous?
Please Select
Yes
No
Sometimes
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Yes
No
Sometimes
Really cares about my pet(s)
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Yes
No
Sometimes
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Yes
No
Sometimes
Listens to my questions and concerns?
Please Select
Yes
No
Sometimes
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Yes
No
Sometimes
Answers all my questions in a way I understand
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9
What was a highlight of your most recent visit?
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10
If you could offer one suggestion to help us better serve you and your pet(s), what would it be?
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11
Would you strongly recommend this veterinary practice to others?
Yes
No
Unsure
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