Customer Satisfaction Survey Template Question Title * 1. How did you hear about Metro Emergency Animal Hospital? Your veterinarian Yellow Pages Web search Friend or Family Member Other (please specify) Question Title * 2. If you called the Clinic before coming in, was your call answered promptly? Yes No Not Applicable Question Title * 3. Approximately how far away are you from the Metro Emergency Animal Clinic? Less than 15 min 15-30 min 30-45 min an hour plus Question Title * 4. What was the reason for your visit? Question Title * 5. On the day of your visit, were you warmly greeted by our receptionist? Yes No Comments Question Title * 6. Were you seen by a veterinarian or veterinarian technician within your expected wait time? Yes No Comment Question Title * 7. Please rank various aspects of you interaction with the veterinary team and the quality of care your pet received. Very Poor Poor Average Very Good Excellent Thoroughness of pet exam Thoroughness of pet exam Very Poor Thoroughness of pet exam Poor Thoroughness of pet exam Average Thoroughness of pet exam Very Good Thoroughness of pet exam Excellent Courtesy and Care by Veterinary team Courtesy and Care by Veterinary team Very Poor Courtesy and Care by Veterinary team Poor Courtesy and Care by Veterinary team Average Courtesy and Care by Veterinary team Very Good Courtesy and Care by Veterinary team Excellent Encouraged to ask questions Encouraged to ask questions Very Poor Encouraged to ask questions Poor Encouraged to ask questions Average Encouraged to ask questions Very Good Encouraged to ask questions Excellent Explanation of condition Explanation of condition Very Poor Explanation of condition Poor Explanation of condition Average Explanation of condition Very Good Explanation of condition Excellent Explanation of required care Explanation of required care Very Poor Explanation of required care Poor Explanation of required care Average Explanation of required care Very Good Explanation of required care Excellent Explanation of our bill Explanation of our bill Very Poor Explanation of our bill Poor Explanation of our bill Average Explanation of our bill Very Good Explanation of our bill Excellent Question Title * 8. Overall, how satisfied or dissatisfied are you with Metro Animal Emergency Clinic? Very satisfied Somewhat satisfied Neither satisfied nor dissatisfied Somewhat dissatisfied Very dissatisfied Question Title * 9. How likely is it that you would recommend Metro Emergency Animal Clinic to a friend or colleague? Not at all likely Extremely likely 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 Question Title * 10. Do you have any other comments, questions, or concerns? Question Title * 11. Where you able to easily find the Metro Emergency Animal Clinic? Yes No Comments Question Title * 12. Thank you for taking the time to complete our survey. We appreciate your input and are offering everybody who completes the survey a chance to be entered to win a $75 Sobey's Gift Card. You can simply provide your name and phone number below or if you'd like to keep the survey anonymous, simply send an email to sbm@eastlink.ca, stating, enter me in your customer survey draw. Submit response
