UM-Veterinary Medical Teaching Hospital
Referring Veterinarian Survey

 

Thank you in advance for taking the time to complete this questionnaire.  Our goal is to be your first choice referral institution through providing consistently excellent service to you and your client.

We anticipate completing this survey should take 5-10 minutes. The survey can be partially completed if your time is limited. The initial sections are questions with specific choices. At the end of the survey, there are boxes for free-form entry to describe your experiences with different areas of the referral process. When you send your survey, it will be reviewed by the faculty clinician in charge of the area as well as hospital administrators. While not necessary, we encourage you to provide your contact information to allow us to follow up if a problem occurred

 

To which VMTH Service did you refer?*  

if other, please specify:

Time of day of Initial Telephone Call:

Monday-Friday 8am- 5pm
 Monday-Friday 5pm-10pm
 Weekend/Holiday 8am-3pm
 Weekend/Holiday 3pm-10pm
 Any overnight 10 pm-8am

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

Client and Patient Name:

Was the initial call answered on a timely basis? Yes  No

Name of person receiving initial call:

How long were you on hold waiting for a clinician?  minutes

If you left a message for a clinician, when did you receive a call back:
 

The call was routed appropriately in a timely fashion:

Strongly Agree
Moderately Agree
Neutral
Moderately Disagree
Strongly Disagree

The operator was helpful:

Strongly Agree
Moderately Agree
Neutral
Moderately Disagree
Strongly Disagree

The person scheduling the appointment was helpful

Strongly Agree
Moderately Agree
Neutral
Moderately Disagree
Strongly Disagree

Ease of the appointment scheduling process

A breeze
Moderately Easy
Neutral
Somewhat Cumbersome
Unduly Cumbersome

Availability/timeliness of the appointment for your patient’s needs:

Very Convenient
Moderately Convenient
Neutral
Moderately Inconvenient
Very Inconvenient

 

The veterinarian's name(s) and/or specialty service(s) who worked with your client:

Was the client satisfied with our service? Yes  No Somewhat  Not Sure

How long from the time of your client’s initial visit did you receive communication about the visit?

With whom did you communicate (check all that apply)?

Student
 Intern
 Resident
 Faculty Clinician
 Don't know
 

Was communication written (letter, fax), verbal (telephone call), both, or neither?

How long after discharge from the hospital/ appointment did you receive communication about the visit?

Were all communications timely and frequent enough to satisfy you? Yes  No

Did the clinician communicate effectively the problems identified, differentials or diagnosis, and plan? Yes  No

Were the client and animal returned to you for continuing care at an appropriate time? Yes  No

Did you have the information you needed to continue to care for this animal? Yes  No

 

Overall rating of your satisfaction with the entire referral process:

Strongly Satisfied
Moderately Satisfied
Neutral
Moderately Dissatisfied
Strongly Dissatisfied

Likelihood of your referring future clients:

Highly Likely
Moderately Likely
Neutral
Moderately Unlikely
Highly Unlikely

 

Please comment on specific aspects of your referral experience:

Switchboard:

Scheduling:


Your Client and Patient Needs:


Personal Issues:


Overall Assessment:


Recommendations for us to improve our service to you:

 

Referring Veterinarian Name (optional):

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

E-mail Address (optional):