Surgery Visit Survey

Name (Optional)

Date of visit:

Approximate time:

How did you hear about us?

If other, please explain:

If you called to make an appointment were you put on hold?

How long were you on hold before your call was answered by a customer service representative?

Did the Customer service person answer your questions in a timely manner?

Was the appointment process easy?

Did you receive your yellow reminder card?

Were you contacted by HSSBV prior to your pet’s surgery?

Were you informed about bringing medical records/vaccine records the day of surgery?

When you entered the clinic were you greeted with a smile by a receptionist?

Were staff members wearing uniforms/name tag?

Did employee appearances seem professional?

Was the reception area clean and orderly?

The receptionist attitude was:

Were you informed at check in about the wait time?

Did receptionist ask you to verify your current address and phone number?

Were you given a “picking up your pet” handout by receptionist at check in?

The vet assistant/technician attitude was:

Did the technician/vet assistant review the estimate with you and inform you about your pets wellness needs (recommended vaccines and other wellness services)?

Did the technician/vet assistant perform a physical exam on your pet?

Did the technician/vet assistant tell you what was happening throughout the visit?

Did the technician /vet assistant ask you if you had any questions or concerns before admitting your pet?

Were you contacted by a recovery staff member by phone when your pet was out of surgery?

At check out, did receptionist review charges with you?

Did recovery staff review medications and aftercare instructions at release?

Did you receive a wellness information package from the recovery staff?

Were you told when to return for a recheck or follow up care (vaccine boosters, suture removal etc)?

Were you able to get a surgery appointment within

Was this pet vaccinated here previously?

Were you informed that vaccines would be given the day of the surgery if you did not bring in the vaccine records?

On a scale of one to ten, with ten being the best, how did the clinic rate?

What were the best aspects of your visit?

What were the weakest aspects of your visit?

If you would like a manager to contact you regarding this survey, please provide your name and phone number or email address.

Your Name:

Your Phone:

Your Email: