Date of your visit:  

 How did you choose our clinic?  (check all that apply)
I drove by     Found in Yellow Pages     A friend/relative recommended the practice
Animal Foundation     Dewey Animal Shelter
Other - Please specify:

 The parking lot/grounds are: 
Clean and well-maintained Yes  No
Large enough Yes  No

 The reception area is: 
Comfortable Yes  No
Neat and clean Yes  No
Odor-free Yes  No

 The office hours are convenient:  Yes  No

If you selected "No," please specify times that would be more convenient for you to visit:

 When I telephoned: 
My call was answered promptly Yes  No
It was easy to make an appointment Yes  No

 The receptionist(s): 
Smiled and greeted me Yes  No
Were friendly and cheerful  Yes  No
Were hospitable and attentive Yes  No

 The doctor(s): 
Had a good bedside manner Yes  No
Explained the exam procedures clearly Yes  No
Clarified the needed treatment/costs Yes  No
Allowed me to ask questions Yes  No
Informed me of other needed services/vaccines Yes  No

 My overall opinion of the clinic was: 

Comments:

What can we do to improve your next visit?

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