Patient Survey Form

PALM PLAZA PET HOSPITAL 2501 E. PALMDALE BLVD. PALMDALE, CALIFORNIA 93550 TELEPHONE US AT: (661) 272-4551

E-MAIL US

HOURS OF OPERATION

Monday & Tuesday

9:00 am to 6:00 pm

Wednesday

9:00 am to 6:00 pm

VACCINE CLINIC

11:00 am to 3:00 pm

Thursday & Friday

9:00 am to 6:00 pm

Saturday

9:00 am to 4:00 pm

Sunday

VACCINE CLINIC

ONLY

8:00 am to 1:00 pm

Telephone Us For

An Appointment

(661) 272-4551

FAX Us At

(661) 266-3341

This Veterinary

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Patient Satisfaction Survey

We would like to know how you feel about the services we provide so we can make sure we are meeting your needs. Your responses are directly responsible for improving these services. All responses will be kept confidential and anonymous. After completing the survey, click "SUBMIT" and you will receive a coupon worth $5.00 off on your next visit to Palm Plaza Pet Hospital. Thank you for your time.

Your Name

Your Pet's Name Your Pet's Breed

Approximate date of your last visit to Palm Plaza Pet Hospital

What services did you have performed?

Your E-Mail Address

Please check the box with the corresponding number to tell us how well

you think we are doing in the following areas:

GREAT: 5 GOOD: 4 SATISFACTORY: 3 FAIR: 2 POOR: 1

Ease of getting care for your pet:

Ability to get an appointment: 5 4 3 2 1
Hours Clinic is open: 5 4 3 2 1
Convenience of Clinic's location: 5 4 3 2 1
Prompt return of call after leaving message: 5 4 3 2 1

Waiting Time:

Time in waiting room: 5 4 3 2 1
Time in exam room: 5 4 3 2 1
Waiting for tests to be performed: 5 4 3 2 1
Waiting for test results: 5 4 3 2 1

Veterinarian:

Listens to you: 5 4 3 2 1
Takes enough time with you and your pet: 5 4 3 2 1
Answers all of your questions completely: 5 4 3 2 1
Gives you good advice and treatment: 5 4 3 2 1

Veterinary Technicians and Assistants: