Email Address

First Name

Last Name

Pets Name

Phone Number

Q1. When you initially contacted Skyline Veterinary Hospital to schedule your appointment, did we answer right away or were you placed on hold?

Right Away Placed on Hold

Q2. When scheduling your appointment, the receptionist was

Courteous / Friendly Rushed / Impatient Bored / Uninterested

Q3. Upon arrival, how would you rate the friendliness of the staff at the front desk?

Outstanding Good Adequate Needs Improvement

Q4. How long did you wait in the reception area beyond your scheduled appointment time?

0-5 mins 5-10 mins 10-15 mins 20 or more mins

Q5. During your appointment, did the technician welcome you and treat you and your pet in a professional and courteous manner?

Yes No Doctor brought me into appointment

Q6. Do you feel that your veterinarian spent an adequate amount of time with you?

Yes No Technician appointment only

Q7. Please fill in the blank: What was the demeanor of your veterinarian?

Examples include: Attentive, Rushed, Concerned, Friendly, Distracted, Inconsiderate

Q8. Do you feel that the veterinarian's exam of your pet was thorough?

Yes No

Q9. Would you recommend Skyline Veterinary Hospital to family and friends?

Yes No

Q10. Are there any other comments or concerns you would like us to know about?

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