You can print this form, complete it with a pen, and mail it, 
or fill it in using your editor and attach it as an email to bobs@hawcreekanimalhospital.com


Name:						Date of Visit:		

Telephone Number:				Email Address:


Please answer "yes" or "no" to the following:


Did we answer the phone promptly when you called for an appointment?			_____

Was the telephone response friendly and courteous?					_____

How promptly were you able to schedule a visit?						_____

Were you able to find the clinic and to park conveniently?				_____



From 1 (poor) to 10 (excellent) how would you rate the following:


How was the check-in proceedure and the staff member who checked you in?		_____

How close to your scheduled appointment were we able to see you?			_____

Was the technician who did the preliminary work friendly and competent?			_____

How well did the doctor adequately explain the examination and diagnosis?		_____

How well did the doctor adequately discuss your treatmant options?			_____

How clear were your home-treatment and follow-up instructions				_____

During check-out how well was your bill explained to you?				_____

How did you feel about "value for money" for your visit?				_____



Please tell us a little about the reasons for your visit, and if 
it was a non-routine visit please tell us how things worked out.




Please take a moment to tell us anything else about your visit you feel we should hear.




Please tell us if there are other services or products you'd like us to add.




May we follow up with a telephone call if there is anything in your responses we'd like to discuss with you?


Thank you for your time and for helping us improve!