About The Clinic

How were you referred to our office?
Friend
Neighbor
Drove By
Internet Search
Yellow Pages
Other (Please Specify)

Our parking availability/lot/grounds:
 Adequate Parking
 Inadequate Parking
 Clean
 Littered or Unkempt

Our waiting room was:
Please Check all that apply.
 Comfortable
 Neat and Clean
 Unomfortable
 Disorderly
 Odor-Free
 Needed Odor Control
 Child-Friendly

Your phone conversation was:
Please check all that apply.
 Courteous
 Hurried
 Impolite
 Informative
 Preoccupied
 Did Not Phone

Our Technicians:
Please check all that apply.
 Greeted You Warmly
 Was Gentle with Your Pet
 Seemed Proficient
 Was Knowledgeable
 Was a Poor Communicator

About Your Experience

Was Your Waiting Time Reasonable?
Yes
No

Approximately how long did you wait to be seen? 

Did you understand our fees?
Yes
No

Do you feel the fees were reasonable?
Yes
No

If you checked "no" to any of the above questions, please discuss below:

Other Comments

What Made you choose the VMCLI to take part in your pets heakthcare

Have you recommended us to others?
Yes
No

If so, Why or Why Not

If you were our practice manager, what suggestions would you have for improving the office, staff or procedures

May we call you to follow up with any concerns?
Yes
No

Your Name: 

Your Phone Number: