Vaccination Visit Survey

Name (Optional)

Date of visit:

Approximate time:

How did you hear about us?

If other, please explain:

Was the reception area clean and orderly?

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?

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?

The vet assistant/technician attitude was:

Did the technician/vet assistant verify vaccine information?

Did technician/vet assistant inform you about your pets wellness needs (Recommend vaccines and other wellness services)?

Did you receive a wellness information package from the technician/ vet assistant?

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 concluding the visit?

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: