Thank you for placing your
pet’s health concerns in our hands. We value your trust and our two main
goals are to provide the best care possible for your pet and to make
your visit an enjoyable one with friendly service. However, we need
your help to make sure that we are meeting or exceeding your needs and
expectations.
Please take a few minutes
to complete our online survey so that we may constantly improve our
services for you and your pets. Your feedback is the only way we can
find out about things we are doing well (we all need a pat on the back
every now and then) and things we didn't do so well (how can we fix the
problem if good people like you don't let us know that we have a
problem?!). So whether you had an awesome experience with us or an
experience that did not meet your expectations, please let us know.
Your Information
First Name, Last Name
Telephone Number
One of your pets' names
Approximate date of your
last visit
Use
this format: 01/01/06
May we call you back to
follow up with any of your concerns?
Yes
No
The Reception Area
Comfortable
Yes
No
Neat and clean
Yes
No
Odor-free
Yes
No
When I telephoned
My call was answered
promptly
Yes
No
It was easy to make an
appointment
Yes
No
I received a convenient
appointment
Yes
No
The Receptionist answered
all of my questions
Yes
No
The Receptionist was polite
Yes
No
When I visited the practice,
The Receptionist
Smiled and greeted me
Yes
No
Was polite and friendly
Yes
No
Verified my name, my pet's
name and why I was here
Yes
No
Informed me if the doctor
was behind schedule
Yes
No
Went over the invoice with
me and gave me a receipt
Yes
No
Offered to help me carry
food or help with my pet out to my car (if needed)
Yes
No
On a scale of 1-5 with 1
being poor, 3 being average and 5 being excellent, how would you rate
our receptionists?
If you answered something
other than 4 or 5, please let us know what went wrong:
The Exam Room
Receptionist/Technician
Smiled and greeted me
Yes
No
Was polite and friendly
Yes
No
Verified why I came in and
the services desired
Yes
No
Answered any questions I had
Yes
No
On a scale of 1-5 with 1 being poor, 3 being
average and 5 being excellent, how would you rate your experience in the Exam Room?
If you answered something
other than 4 or 5, please let us know what went wrong:
The Doctor
Who did you see?
Smiled and greeted me
Yes
No
Was polite and friendly
Yes
No
Verified why I came in and
the services desired
Yes
No
Has a good bedside manner
Yes
No
Explained the physical
examination clearly
Yes
No
Discussed any problem areas
in detail
Yes
No
Answered any questions I had
Yes
No
Provided a Summary of
Treatment Recommendations (Estimate) for a recommended surgery/dental or
other recommended medical treatment
Yes
No
On a scale of 1-5 with 1 being poor, 3 being
average and 5 being excellent, how would you rate your experience with
your Doctor?
If you answered something
other than 4 or 5, please let us know what went wrong:
Your Time
We value your
time. One of our main goals is to work as quickly as possible while
giving each of our clients the full attention they deserve. Due to the
nature of healthcare (emergencies, traffic causing clients not to arrive
on time, unexpected problems discovered during examination, etc...),
most delays are beyond our control. But, we want you to be happy and for
your wait to be reasonable. What did you experience during your
visit?
Amount of time before a
Receptionist acknowledged me and checked me in
Time waited until I first
saw an Exam Room Assistant
Time waited until I first
saw the Doctor
Length of visit with Doctor
in exam room
Time waited after Doctor
finished until check-out
Time it took to pay and go
over invoice (check-out)
Is there anyone at our
hospital who provided you with exceptionally good OR really poor
service? If so, please give us a little information so we can pat them
on the back or kick them in the pants!
Would you recommend our
hospital to others?
Were you satisfied with the
value of services received during your visit?
Yes
No
On a scale of 1-5 with 1
being poor, 3 being average and 5 being excellent, what is your overall
opinion of Prairie Village Pet Hospital?:
Other comments and is there
anything we can do to improve your next visit:
Please be sure
to hit the Submit button below (just once) to send us the form. Thank
you for your time and interest in helping us improve your veterinary
hospital!
Do to computer program issues please print your survey and mail to
