UMC-Veterinary Medical Teaching Hospital
Client Satisfaction Survey

 

Thank you in advance for completing this questionnaire.

THE Service you received

Which VMTH Service did you visit? 

if other, please specify:

Background Questions

Date of this visit:  

Was this the first time you used our services?  Yes  No

Patient's name or tag number (whichever is appropriate):

Were you referred by a veterinarian? Yes  No
     by a friend or acquaintance?  Yes  No

How many minutes did you wait after your scheduled appointment before you were called to the examination room or area? minutes

How many minutes did you wait in the examination room? minutes

On what day was your most recent visit? 

At what time of day was your most recent visit?

What was the veterinarian’s name that examined/treated your animal?


Instructions: Please rate the service you received from our facility. Rate only the service you selected above. Select the option that best describes your experience.  If a question does not apply to you, please skip to the next one. Space is provided for you to comment on good or bad experiences that you may have had while visiting our facility.
 
switchboard Operator Very Poor Poor Fair Good Very Good
Initial call answered on a timely basis
Call routed appropriately in a timely fashion
Was the operator knowledgeable

Comments (describe good or bad experience):

 

registration Very Poor Poor Fair Good Very Good
Helpfulness of the person at the registration desk
Ease of the registration process
Waiting time at registration

Comments (describe good or bad experience):

 

facility Very Poor Poor Fair Good Very Good
Comfort of the waiting area
Ease of finding your way around
Cleanliness of the facility

Comments (describe good or bad experience):

 

your animal's Evaluation and/or treatment Very Poor Poor Fair Good Very Good
Friendliness/courtesy of the individual who provided the evaluation or treatment
Explanation from the individual about what would happen during the evaluation or treatment
Skill of the individual who provided the evaluation or treatment
Our concern for your comfort and your animal's comfort
Our concern for your questions and worries

Comments (describe good or bad experience):

 

personal issues Very Poor Poor Fair Good Very Good
Our sensitivity to your animal's needs
Were the needs of your animal met
Our sensitivity to your needs
Response to concerns/complaints made during your visit

Comments (describe good or bad experience):

 

Overall Assessment Very Poor Poor Fair Good Very Good
How well did we work together to provide care
Overall rating of care received during your visit
Likelihood of your recommending our facilities to others

Comments (describe good or bad experience):

 

Client's Name (optional):

Telephone Number (optional):   example 555-555-5555

E-mail Address (optional):