Service:    A    B    C    D    F   

Cleanliness:    A    B    C    D    F   

Waiting time:    A    B    C    D    F   

Was our receptionist helpful?    Yes    No

Was the technician caring with your pet?    Yes    No

Was the doctor thorough in explaining    Yes    No
your pet's problem?

Were the medications explained to you?    Yes    No

Were the prices and professional fees what you expected?   Yes    No

If not, please explain:

Comments/suggestions:

How did you first learn of Pet Vet? Newspaper Radio Referral Sign Television Yellow Pages Other
Other:

Date of visit: *    Time of visit:

Hospital visited: Bay Area Boulevard Highway Six Katy Freeway Midway - Dallas Southwest Freeway *

First name: *

Last name: *

E-mail address: *

Phone number(s):

Should we need further information, may we contact you?
     Either media    E-mail only    Phone only    No