Your Feedback

Orchard Park Veterinary Medical Center

Your Feedback

We at Orchard Park Veterinary Medical Center are always looking for ways to improve our products and services we offer you. Your suggestion, ideas, and comments are always welcome.

We would appreciate it if you would take a few moments to complete our on-line survey.

Form - Your Feedback Form

Name
First Name	Last Name

Address
Street Address


City	State/Province	Zip/Postal Code
,

Phone
Phone Type	Phone Number

E-Mail Address :

Client Identification #:

Date of your visit:

Doctor you saw:

For your visit today, did you have :

Service/Experience Rating
Please rate your experience on a scale of 1 - 5, with 5 being the highest, in each of the below categories.

Please rate your overall experience with OPVMC:
1
2
3
4
5

Our staff met or exceeded your expectations today:
1
2
3
4
5

Your wait time was appropriate:
1
2
3
4
5

Approximately how long did you wait?

Any service delays were explained to your satisfaction:
1
2
3
4
5

You would recommend our pratice to friends and family:
1
2
3
4
5

Comments/suggestions:

May we contact you to discuss any of your ratings or comments?
Yes
No

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