1.	Which part of the Veterinary Medical Teaching Hospital did you visit?*
	Large Animal Hospital Small Animal Hospital

2.	Why did you choose to bring your animal(s) to the Veterinary Medical Teaching Hospital?
	Referred by a veterinarian    General reputation of the clinic    Recommended by a family member, friend or neighbor    Telephone directory    Other, please specify

3.	Is this your first visit to the Veterinary Medical Teaching Hospital?
	YesNo

4.	Were you satisfied with the date and time of your appointment?
	YesNo

5.	How would you grade the Veterinary Medical Teaching Hospital's ability to answer your calls promptly and handle them in a courteous fashion?
	A+ A B+ B C D F N/A Other, please specify

6.	What grade would you give the VMTH's receptionists that greeted you?
	A+ A B+ B C D F N/A Other, please specify

7.	What grade would you assign the VMTH for the length of your wait in the reception while your animal was being treated?
	A+ A B+ B C D F N/A Other, please specify

8.	How would you grade the professional staff and students that took care of your animal?
	A+ A B+ B C D F N/A Other, please specify

9.	What grade would you give the VMTH on the explanation given for your animal's problem?
	A+ A B+ B C D F N/A Other, please specify

10.	How would you grade the initial estimate of costs, considering the circumstances surrounding your animal's illness or injury?
	A+ A B+ B C D F N/A Other, please specify

11.	What grade would you give the Veterinary Medical Teaching Hospital on the fees charged?
	A+ A B+ B C D F N/A Other, please specify

12.	Based on your overall experience, what grade would you give the Veterinary Medical Teaching Hospital?
	A+ A B+ B C D F N/A Other, please specify

13.	Additional Comments: (optional)

14.	Contact Information: (optional)