Heritage Veterinary Hospital Patient Satisfaction Survey

Your Name

Your Pet's Name

Your Pet's Breed

Approximate date of your last visit

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. After completeing the survey, click "SUBMIT".

Your Survey will be forwarded to our Office Supervisor and we will send you a coupon worth $5.00 off on your next visit to County Line Veterinary Hospital or Heritage Veterinary Hospital.
Thank you for your time.

Your appointment was with:

Dr. Bruce Weitzner

Dr. Marc Rosenberg

Technician Appointment

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 Hospital is open:

5

4

3

2

1

Waiting time:

Time in exam room:

5

4

3

2

1

Veterinarian:

Takes enough time with you and your pet:

5

4

3

2

1

Answers all of your questions completely:

5

4

3

2

1

Veterinary Technicians and Assistants:

Friendly and helpful to you:

5

4

3

2

1

Answers your questions:

5

4

3

2

1

Reception Staff:

Friendly and helpful to you:

5

4

3

2

1

Answers your questions:

5

4

3

2

1

Your experience:

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

Definitely

Probably

Maybe

Never

Did any particular Veterinary Technician or Assistant
provide exceptional care during your visit to our hospital?

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" and we will send your $5.00 Coupon.

* Indicates Response Required