Reputation Management Questionnaire

Your Name*

Business Name:*

Your Email*

Widget Settings

Shipping Address*

This is where we will deliver your custom QR Code Counter Card when it is ready.

Street Address City State / Province / Region ZIP / Postal Code Country

Star Threshold

Which star count would you like to redirect to the "Write us a review!" page? (Note: Lower star selections will redirect to the Client Survey form with the questions you select below).

3.5 stars & up
4 stars & up
4.5 stars & up
5 stars only

Email to Send Survey Submissions To:*

This is where the Client Survey submissions will be sent for review.

I represent a...

Veterinary Practice
Human Medical Practice (Chiropractic, Dental)
Other Business

VET Client Survey Questions

These are the questions that will be asked for clients who select a lower rating. Their answers will be submitted to the email entered above.

We recommend choosing only 5 or less questions total to keep the survey short so people are more likely to fill it out.

Appearance

The exterior of the practice is well kept and inviting.
The interior of the practice is clean, organized, comfortable, and has a good fragrance.
The appearance of our healthcare team was professional and clean.

Client Care

The greeting you received when you last called our clinic was friendly and professional.
The waiting time while on - hold was acceptable.
The time between leaving a message and receiving a return call was satisfactory.
The availability of an appointment with my preferred doctor was adequate.
The greeting you and your pet received upon check-in was friendly and courteous.
The amount of time you waited in the reception area was appropriate considering appointment time and arrival time.
The amount of time you waited in the exam room was acceptable.
The check - out process was convenient and timely.
The invoice you received was accurate.

Patient Care

The healthcare team treated your pet with care and compassion.
The attention given to your pet's past history was adequate.
The doctor's examination of your pet was thorough.
The doctor's medical explanation of your pet's condition and health recommendations was clear.
The healthcare team made sure all your questions were answered.

Overall Rating

The overall experience at our clinic was satisfactory.
The quality of service and care given to your pet in relation to the associated cost was a good value.
I will recommend this clinic to friends and family.
I will continue to bring my pet to this clinic.
Was there a specific doctor or staff member that you feel provided service that went above and beyond?

Human Medical Client Survey Questions

These are the questions that will be asked for clients who select a lower rating. Their answers will be submitted to the email entered above.

We recommend choosing only 5 or less questions total to keep the survey short so people are more likely to fill it out.

Appearance

The exterior of the practice is well kept and inviting.
The interior of the practice is clean, organized, comfortable, and has a good fragrance.
The appearance of our healthcare team was professional and clean.

Client Care

The greeting you received when you last called our clinic was friendly and professional.
The waiting time while on - hold was acceptable.
The time between leaving a message and receiving a return call was satisfactory.
The availability of an appointment with my preferred doctor was adequate.
The greeting you received upon check-in was friendly and courteous.
The amount of time you waited in the reception area was appropriate considering appointment time and arrival time.
The amount of time you waited in the exam/treatment room was acceptable.
The check - out process was convenient and timely.
The invoice you received was accurate.

Patient Care

The healthcare team treated you with care and compassion.
The attention given to your past history was adequate.
The doctor's examination was thorough.
The doctor's medical explanation of your condition and health recommendations was clear.
The healthcare team made sure all your questions were answered.

Overall Rating

The overall experience at our clinic was satisfactory.
The quality of service and care given in relation to the associated cost was a good value.
I will recommend this clinic to friends and family.
I will continue to come to this clinic.
Was there a specific doctor or staff member that you feel provided service that went above and beyond?

General Client Survey Questions

These are the questions that will be asked for clients who select a lower rating. Their answers will be submitted to the email entered above.

We recommend choosing only 5 or less questions total to keep the survey short so people are more likely to fill it out.

Appearance

The exterior of the office is well kept and inviting.
The interior of the office is clean, organized, comfortable, and has a good fragrance.
The appearance of our team was professional and clean.

Client Care

Overall Rating

Your experience with our business was satisfactory.
The quality of service in relation to the associated cost was a good value.
I will recommend this business to friends and family.
I will continue to use your business services.
Was there a specific team member that you feel provided service that went above and beyond?

Custom Questions

If you have your own questions you would like to use on the survey instead, please include them below:

Custom Question