Name (*)

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Email (*)

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Invoice Number

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Clinic Location
Beach Blvd./San PabloJax Beach/3rd Street
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Reception Evaluation

Please Rate the following: (1 lowest through 4 highest)

When you call, is the phone answered promptly?
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If you were put on hold, were you answered back in a reasonable amount of time?
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Do you feel the clinic hours are convenient to your personal needs?
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Are you treated courteously over the phone and in person by the reception team?
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How would you rate the cleanliness of the reception area?
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Do you feel the check-in process is efficient?
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Do you feel the check-out process is efficient?
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Technician/Nursing Evaluation

Do you feel our nursing staff offers adequate education and guidance on common pet-related issues?
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Do you feel our nursing staff is courteous and friendly?
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Do our nurses know your pet(s) medical history and answer your questions to your level of comfort?
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Are your pet(s) happy to see us when they come in? (you can be honest)
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How would you rate the cleanliness of the exam rooms?
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Doctor Evaluation

Do you feel the doctor spent adequate time with you and your pet(s)?
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Do you feel our doctors are courteous and friendly?
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When medical recommendations are made, do you feel enough education is given for you to make a confident decision as an advocate for your pet?
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Do you feel the fees associated with services and products are fair?
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When medications are prescribed, do you feel side-effects and proper education are given?
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Overall Evaluation

How would you rate your overall impression of our facility?
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How would you rate your overall impression of our team and doctors?
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Based on your visits to our clinic, would you recommend us to your family & friends?
YesNo
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Additional Suggestions or comments:

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Thank you for participating in this survey. We are constantly striving to better ourselves and the services we provide. Our goal is to not only meet your expectations, but to exceed them. If we ever fall short of those goals, please do not hesitate to contact the management so we can learn from our mistakes. We thank you for your time and appreciate your honest opinions.