Date of visit:
Doctor seen:
Was your appointment time convenient?
Yes
No
Somewhat
Were you offered a same day appointment?
Yes
No
Didn't schedule an appointment.
How friendly was the front desk staff:
Very Friendly
Somewhat Friendly
Somewhat Unfriendly
Very Unfriendly
Did the front desk staff have a professional appearance?
Very Professional
Somewhat Professional
Somewhat Unprofessional
Very Unprofessional
Please rate the cleanliness and appearance of the front desk area:
Excellent
Good
Fair
Poor
How long of a wait did you have before being seen by a doctor?
I was seen before my scheduled time.
I was seen within 5 minutes of my scheduled time.
I had a 5 to 15 minute wait after my scheduled time.
I waited for more than 15 minutes after my scheduled time.
How friendly was the doctor's technician or assistant?
Very Friendly
Somewhat Friendly
Somewhat Unfriendly
Very Unfriendly
Please rate how well the technician or assistant answered your questions:
Excellent
Good
Fair
Poor
Did the doctor have a professional appearance?
Very Professional
Somewhat Professional
Somewhat Unprofessional
Very Unprofessional
Please rate the doctor's attitude:
Excellent
Good
Fair
Poor
Please rate how well the doctor listened to you during your visit:
Excellent
Good
Fair
Poor
Please rate the overall thoroughness of your pet's exam:
Excellent
Good
Fair
Poor
Please rate the doctor and staff's recommendations about your pet's health:
Excellent
Good
Fair
Poor
Please rate how the doctor and staff handled your pet:
Excellent
Good
Fair
Poor
How do you feel about the overall fees associated with your visit?
Very high
Somewhat high
Fair
Somewhat low
Very low
Please rate the speed of checking out:
Excellent
Good
Fair
Poor
If you were given a prescription, was it in stock?
Yes
No
I wasn't prescribed anything.
How long did you have to wait to recieve your prescription?
I got the prescription right away.
I got the prescription within 5 minutes.
I got the prescription within 5 to 10 minutes.
I waited for more than 10 minutes.
Please rate the quality of your visit to Pet Kare Clinic:
Excellent
Good
Fair
Poor
Please rate the value of your visit to Pet Kare Clinic:
Excellent
Good
Fair
Poor
Would you recommend Pet Kare Clinic to a friend or family member?
Very likely
Somewhat likely
Somewhat unlikely
Very unlikely
Will you return to Pet Kare Clinic?
Very likely
Somewhat likely
Somewhat unlikely
Very unlikely
What did you like most about your visit to Pet Kare Clinic?
What did you like least about your visit to Pet Kare Clinic?
