Palm Plaza Patient Satisfaction Survey Form

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous. After completeing the survey, click "SUBMIT" and you will receive a coupon worth $5.00 off on your next visit to Palm Plaza Pet Hospital.

LIMIT ONE COUPON PER FAMILY
Thank you for your time.

Your Name

Your Pet's Name

Your Pet's Breed

Approximate date of your last visit
to Palm Plaza Pet Hospital

What services did you have performed?

Your E-mail Address

Please check the box with the corresponding number to tell us how well
you think we are doing in the following areas:

GREAT: 5 GOOD: 4 SATISFACTORY: 3 FAIR: 2 POOR: 1

Ease of getting care for your pet:

Ability to get an appointment:

5

4

3

2

1

Hours Clinic is open:

5

4

3

2

1

Convenience of Clinic's location:

5

4

3

2

1

Prompt return of call after leaving message:

5

4

3

2

1

Waiting time:

Time in waiting room:

5

4

3

2

1

Time in exam room:

5

4

3

2

1

Waiting for tests to be performed:

5

4

3

2

1

Waiting for test results:

5

4

3

2

1

Veterinarian:

Listens to you:

5

4

3

2

1

Takes enough time with you and your pet:

5

4

3

2

1

Answers all of your questions completely:

5

4

3

2

1

Gives you good advice and treatment:

5

4

3

2

1

Veterinary Technicians and Assistants:

Friendly and helpful to you:

5

4

3

2

1

Gentle and kind to your pet:

5

4

3

2

1

Answers your questions:

5

4

3

2

1

Reception Staff:

Give you immediate attention at the front desk:

5

4

3

2

1

Schedule you next appointment efficiently:

5

4

3

2

1

Friendly and helpful to you:

5

4

3

2

1

Answers your questions:

5

4

3

2

1

Fees:

Cost of your visit:

5

4

3

2

1

Explanation of charges:

5

4

3

2

1

Collection of payment/money:

5

4

3

2

1

Hospital Facility:

Clean hospital facility:

5

4

3

2

1

Pet odors in facility:

5

4

3

2

1

Ease of finding hospital:

5

4

3

2

1

Comfort while waiting to see Veterinarian:

5

4

3

2

1

Your experience:

How likely would you be to refer your friends and relatives to us:

Definitely

Probably

Maybe

Never

What do you like best about our hospital?

What do you like least about our hospital?

Suggestions for improvement?

Thank you for completing our Survey!

Click on "SUBMIT" to receive your $5.00 Coupon.

* Indicates Response Required