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(773) 478-0631
CHESHIRE PARTNERS DEMO
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Anesthesia / Surgery Consent Form
Boarding Release Form
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Client Survey
Consent form for dental care
Drop Off Questionnaire for Sick Pet
Heartworm Treatment Release Form
New Patient Form
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Telemedicine Request Form
Well Pet Drop Off Form
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Menu
Digital Client Forms
Anesthesia / Surgery Consent Form
Boarding Release Form
Client Arrival Check-In
Client Survey
Consent form for dental care
Drop Off Questionnaire for Sick Pet
Heartworm Treatment Release Form
New Patient Form
Pay Online
Prescription Refill
Record Release Form
Request an Appointment
Surgery / Dental Drop Off Form
Telemedicine Request Form
Well Pet Drop Off Form
Event Booking System
Lectures
My Bookings
Locations
Team Portal
Documents & Forms
Staff Directory
Announcements
E-commerce
Portfolio
Contact
Client Survey
Please Note: Your privacy is 100% assured.
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Rate your overall experience at our hospital
Excellent
Pretty good
Neutral
Not so great
Terrible
How Did You Choose our Hospital?
A friend or relative recommended the practice
I drove by and saw your hospital sign
I saw the practice in the Yellow Pages
Found you through the Search Engines
Other
Please Explain
Your Telephone Experience
My call was answered promptly
Yes
No
It was easy to make an appointment
Yes
No
I was referred to the hospital website to get necessary forms ahead of time
Yes
No
I was placed on hold too long
Yes
No
I was offered to be called back if needed
Yes
No
I did not phone
Yes
No
Your Impression of our Receptionist (Over the Phone):
Friendly and attentive
Yes
No
Courteous
Yes
No
Informative
Yes
No
Your Impression of our Receptionist (In Person):
Stood and greeted me
Yes
No
Aware of purpose of visit
Yes
No
Seemed warm and cheerful
Yes
No
Gave me undivided attention
Yes
No
Seemed hospitable
Yes
No
Answered all my questions
Yes
No
Your Impression of our Reception Area:
Comfortable
Yes
No
Neat & Clean
Yes
No
Counter tops free from clutter
Yes
No
Retail displays are well organized
Yes
No
Odor-free
Yes
No
Pet-friendly
Yes
No
Your Impression of our Parking Lot/Grounds:
Clean
Yes
No
I found a parking spot with ease
Yes
No
Your Impression of our Hospital Website
I visited the Pet Hospital Website
Yes
No
I found the website to be helpful & resourceful
Yes
No
I printed out any necessary forms ahead of time from the Hospital Website
Yes
No
I registered to be a member and/or to receive free newsletters
Yes
No
Your Impression of our Technician:
Greeted me with warmth
Yes
No
Was gentle with my pet
Yes
No
Seemed proficient and knowledgeable
Yes
No
Gave me the information I needed
Yes
No
Pet-friendly
Yes
No
Your Impression of our Veterinarian:
Introduced himself/herself
Yes
No
Washed his/her hands before examining my pet
Yes
No
Listened to what I said & answered all my questions
Yes
No
Gave clear advice about how to treat my pet
Yes
No
Behaved professional in manner and appearance
Yes
No
Answered all my questions
Yes
No
Comforted me and my pet
Yes
No
Made me feel valued
Yes
No
Additional Questions:
Was your waiting time reasonable?
Yes
No
Do you feel the fees were reasonable?
Yes
No
Did you understand all our fees?
Yes
No
Please Explain
*
Will you recommend us to others?
Yes
No
Why or why not?
What suggestions do you have for improving the office, staff or procedures?
Would you like us to contact you?
Yes
No
Name
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