Thank you so very much for your feedback!! 

It is our passion to make every experience at our hospital the absolute best it can be and we take your feedback and suggestions very seriously.  We appreciate your time and we hope that you look forward to coming back to visit us as much as we look forward to seeing you again!
REASON FOR VISIT
IF YOU DID NOT SEE A DOCTOR DURING THIS VISIT, PLEASE SKIP TO QUESTION # 21
SCHEDULING AN APPOINTMENT
DAY OF APPOINTMENT
9. How would you rate the competence of your doctor?
YOUR VETERINARIAN
We are working hard to expand on your experiences with our hospital which is why we have implemented a Team Medicine approach.  During your visit you  met with one of our doctors as well as one of our Patient Care Coordinators (PCC). 

We would appreciate your feedback on our new appointment structure.
YOUR PATIENT CARE COORDINATOR
OUR RECEPTIONISTS
OVERALL IMPRESSION
Annual Checkup/Wellness Visit
Routine Surgery (i.e., Spay/Neuter)
Dental Prophylaxis/Cleaning
Follow up visit
Diagnostic Testing (X-Ray, Blood, Urine, Ultrasound...etc.)
Pet was ill/not feeling well
Grooming
Food/Product purchase
2. Did you schedule your appointment by phone or did you drop in?
Scheduled by phone
Dropped in
3. How would you rate the demeanor of the person who scheduled your appointment?
Very Courteous
Courteous
Not Overly Courteous
Rude
4. Were you able to see the doctor of your choice?
Yes
No
If no, please explain
5. How would you rate the demeanor of the staff in the Reception area?
Very Courteous
Courteous
Not Overly Courteous
Rude
6. How long did you wait in the reception area beyond your scheduled time?
0 to 5 minutes
5 to 10 minutes
10 to 20 minutes
Over 20 minutes
7. Which doctor did you see during this visit?
Dr. Dana Cox
Dr. Lauren Ames
Dr. Shawna McLaughlin
I cannot remember
8. How would you describe the demeanor of your doctor?  (check all that apply)
Attentive
Concerned
Friendly
Distracted
Inconsiderate
Outstanding
Good
Adequate
Needs improvement
Poor
10. Did you feel that your doctor spent an adequate amount of time with you?
Yes
No
If no, please explain
11. Did you feel that your doctor's examination of your pet was thorough?
Yes
No
If no, please explain
12. Please rate the clarity of the veterinarian's explanation of your pet's condition & treatment
Outstanding
Good
Adequate
Needs improvement
Poor
13. Please rate the ability of the veterinarian to include you in any healthcare decisions
Outstanding
Good
Adequate
Needs improvement
Poor
14. What is your opinion on the incorporation of a Patient Care Coordinator into your appointment?
Very Beneficial
Yes
No
Yes
No
If no, please explain
18. Overall, how would you rate your experience with our Patient Care Coordinator during your visit?
Outstanding
Good
Adequate
Needs improvement
Poor
19. Who was your Patient Coordinator during your visit?
Lynn
Jennifer (J.J.)
I cannot remember
Yes
No
If YES please describe
Yes
No
If no, please explain
Yes
No
If no, please explain
Yes
No
If no, please explain
Yes
No
If no, please explain
25. Overall, how would you describe your experience with our hospital?
Outstanding
Good
Adequate
Needs improvement
Poor
Yes
No
If no, please explain
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Full Name
Email Address
Home Phone
Would you like to sign up to receive SVHNews our monthly e-newsletter?
Yes!
Somewhat Beneficial
Neither Beneficial nor Not Beneficial
Not Beneficial
Outstanding
Good
Adequate
Needs improvement
Poor
16. Did your Patient Care Coordinator provide you with additional literature to take home about your pet's
     health or medication?
1. What was the main purpose for your visit to Smith Veterinary Hospital?
Rushed
15. Please rate the ability of your Patient Care Coordinator to address all your questions and concerns
17. Would you like to see us continue to offer this Team Medicine approach to your pet's care?
20. Did you learn something new today?
21. Upon entering our hospital were you greeted promptly and cheerfully?
22. Did the front reception area appear neat and clean and free from any offensive odours?
23. Were the products you were looking for available?
24. Did you find our receptionists knowledgeable & helpful?
26. Would you recommend our hospital to your friends and family?
How can we improve our service to you?
No, thank you
I already receive SVHNews!
25. Would you like to recognize an SVH Team Member that you believe deserves an 'Excellence In Client Service" award for going above and beyond for you and your pet during your visit with our hospital? 

If so, please indicate your nomination for this award:
Please add any additional comments regarding your nominee for the Excellence In Client Service award