Pet Exam Survey

Name

Pet's Name

Email

Phone Number

May we contact you with any concerns?

No

Yes

Please rate our reception area on a scale of 1 to 5.

1 - Poor

2 - Fair

3 - Just OK

4 - Good

5 - Excellent

While you were there how was the reception area? Check all that apply.

Comfortable

Uncomfortable

Clean

Messy

Odor-free

Smelly

Loud

Quiet

I didn't notice

Are the office hours convenient for you?

No

Yes

Was your call answered promptly?

No

Yes

Where you kept on hold for longer than 2 minutes?

No

Yes

Was the receptionist polite and friendly?

No

Yes

On a scale from 1 to 5 please rate the receptionist.

1 - Poor

2 - Fair

3 - Just OK

4 - Good

5 - Excellent

Please tell any other comments or concerns about reception.

In the exam room was the assistant polite and friendly?

No

Yes

Was the exam assistant helpful and knowledgable?

No

Yes

Did the exam assistant follow through with your requests?

No

Yes

On a scale of 1 to 5 how would you rate the exam room assistant overall?

1 - Poor

2 - Fair

3 - Just OK

4 - Good

5 - Excellent

Tell us any other comments or concerns about your exam experience.

Was your doctor polite and friendly?

No

Yes

Did your doctor discuss any problems or concerns with you?

No

Yes

Did your doctor spend enough time answering your questions?

No

Yes

Who was the doctor you saw on your visit?

Let us know any other comments or concerns about your doctor.

Was there an employee that went above and beyond to make your visit to MyPet's more enjoyable?

Would you refer us to your friends and family for their pet care?

No

Yes

Are there any services we could provide to make you and your pet's day better?

Type the numbers.

Pet Exam Survey

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