HOW ARE WE DOING?
Please take a moment to fill out our survey about the quality of service you and your pet received at our
clinic.  We welcome your feedback whether positive or negative.  We need your input so that we may
serve you and your pet better in the future.
Date and time of visit
On a scale of 1 to 10 (ten being the best), how would you rate your overall experience at The Family Pet Clinic
What can  we do differently to improve your experience (being specific and
critical will not hurt our feelings - if there is something we can improve on, we
want to know.):
Please rate the following:
 Excellent          Good           Fair                Poor
Cleanliness outside our clinic?
Cleanliness inside our clinic?
Convenience of clinic hours
Please rate our staff
Receptionists:
Check the box next to the picture of the receptionist that assisted you or check other if someone else assisted you
Other
Carrie
 Amy
Excellent          Good           Fair                Poor
Checking in
Knowledge
Helpfulness
Exam Room Assistant/Technician:
Check the box next to the picture of the Exam Room Assistant/Technician that assisted you during your visit.
Lisa
Maureen
 Karen
Amy
Chris
Eric
Excellent          Good           Fair                Poor
Helpful,careful, concerned about your pet
Explained procedures, cost, medications, etc., clearly
Knowledge about you and your pet's needs
Veterinarian:
Check the box next to the picture of the Veterinarian that assisted you during your visit.  Check other another Vet.
Dr. Slezak
Dr. Thompson
Excellent          Good           Fair                Poor
Helpful,careful, concerned about your pet
Knowledge about you and your pet's needs
Options given for treatment, including estimates
Explained procedures, medications, etc., clearly
Additional comments:
Check the box if you would like to be contacted regarding this survey
Your Name
Pet's name
Email Address
Phone Number