Client Feedback Form Date What was the reason for your most recent visit to our hospital?Were you greeted promptly and politely? Yes No Please rate each part of your visit: Making an Appointment Excellent Good Fair Poor Please rate each part of your visit: Checking In Excellent Good Fair Poor Please rate each part of your visit: Examination of my pet Excellent Good Fair Poor Please rate each part of your visit: Medical/health recommendations Excellent Good Fair Poor Please rate each part of your visit: Check out Excellent Good Fair Poor Please comment on any fair / poor responsesWhy do you choose to utilize the services at our hospital? Check all that apply. The doctors The staff Quality of Care Value for my money Clean modern facility Variety of services / products offered Location of hospital OtherDid you receive the level of care you expected? Yes No If no, why?Regarding the cost of the services and products that you received, do you feel that: The cost is what I expected The cost was more than I expected The cost was less than I expected Was there any part of your visit that was disappointing or negative? Yes No If yes, please explain.Do you have any unresolved issues/concerns that you would like to address? If yes, please explain. If you would like someone to call you leave your name and number. Yes No If yes, please explain.Please leave your name, telephone number and email if you would like to be contacted. First Last PhoneEmail This iframe contains the logic required to handle AJAX powered Gravity Forms.