Hospital Appointment Request Form - Valley Veterinary Hospital | Serving the Amherst, Hadley, Northampton area

Valley Veterinary Hospital and Inn for Pets

Valley Veterinary Hospital Client Survey

Name (Optional):

General Information
How often have you visited Valley Veterinary Hospital within the past year?


Once	2-5 visits	6 or more visits

When You Telephoned Our Office
Did you have any difficulty reaching a receptionist?


No difficulty	Somewhat difficult	Very difficult

If you were put on hold, did you receive service within a reasonable amount of time?


Very reasonable	Somewhat reasonable	Not reasonable	Not applicable

How convenient were the available appointment times?


Very convenient	Had to rearrange my schedule	I was unable to schedule a convenient time

When You Arrived For Your Appointment
How comfortable did you feel in the waiting area?


Very comfortable	Somewhat comfortable	Not very comfortable

How long did you have to wait in the reception area beyond your scheduled appointment time?


0-5 minutes	5-10 minutes	10-20 minutes	20+ minutes

In the Exam Room
How long did you wait in the exam room before the veterinarian appeared


0-5 minutes	5-10 minutes	10-20 minutes	20+ minutes

How clean did the exam room appear?


Very clean	Somewhat clean	Not very clean

Did you feel that your veterinarian�s exam was thorough and complete?


Very thorough	Somewhat thorough	Not very thorough

My veterinarian was: (mark all that apply)


Attentive	Concerned	Interested	Friendly	Distracted	Rushed	Inconsiderate

How would you rate the competence of your veterinarian?


Exceptional	Good	Adequate	Needs improvement	Poor

Did the veterinarian clearly explain your pet�s condition and treatment options?


All my questions were answered	I'm a little confused	Not clear at all

Our Staff
How helpful were the staff that assisted you?

Reception Staff
	Very helpful	Somewhat helpful	Received little help
Technician/Assistant
	Very helpful	Somewhat helpful	Received little help

How professional were the appearance and mannerisms of the staff that assisted you?

Reception Staff
	Very professional	Somewhat professional	Not very professional
Technician/Assistant
	Very professional	Somewhat professional	Not very professional

Did they have thorough knowledge of our products and procedures?

Reception Staff
	Very thorough	Somewhat thorough	Not very thorough
Technician/Assistant
	Very thorough	Somewhat thorough	Not very thorough

Was there a specific employee that provided exceptional service for you and your pet?

Overall
How much value do you feel you received from the services provided by Valley Veterinary Hospital?


Exceptional value	Good value	Fair value	Little value

How would you rate your experience with Valley Veterinary Hospital?


Exceptional	Good	Needs improvement	Poor

Please explain your overall rating below. Your comments and suggestions are greatly appreciated. Thank you for taking the time to fill out this survey.

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