Vet Feedback Form old

Vet Feedback Form

"*" indicates required fields

Step 1 of 3

RYP Vet Name

If a different vet attended this appointment to what is stated, please confirm your name here

Owner Details

First Name*

Last Name*

Street Address*

Suburb*

State*

Postcode*

Who was present at the appointment? For example: please include names of other family members, friends, children & other pets who were present

Pet Details

Pet's Name*

Pet status*

Aftercare Details

Preferred Aftercare Option*

Name of Aftercare Provider

Did the Owner mention anything about their aftercare wishes, vessel choice etc.? Please include any changes requested by the Owner e.g. from communcal to private, or changes to a particular vessel, piece of jewellery, engraving etc.

Please confirm what was mentioned by the Owner in terms of aftercare wishes

Pick-Up Location as noted by the RYP CCT

Has the AC Provider pick-up location changed from what is set out?

If the Pick-Up Location changed, please let us know where the pet should be collected after the appointment (e.g. Dr. Kathy's freezer, My freezer etc.)*

Any other comments or follow-ups to request from the Care Team? Particular resources for the family/grief counseling?

Vet Appointment Feedback

Did you light a candle or leave a candle for them to light later?*

Did you make ink paw prints?*

Did you take fur clippings?*

Did you give a treat?*

You did not offer some services, can you explain why?

Did the appointment go well from the client’s perspective?*

Did the appointment go well from a veterinary perspective?*

If not, briefly explain why not*

Should we ask for a Google review or ask for the family to provide feedback to their Reg Vet? Please note, we will only ask the family in response to beautiful feedback, not unprompted*

If not, please explain why not and flag any concerns you may have about the appointment so we can follow up accordingly

Please select any other follow-up items we should consider

Other: please provide more info

Vet Appointment Feedback

Did you administer or dispense any Medication?

If yes, what medication did you administer? (include any injections given or meds: drug name, dose, number of tablets or volume dispensed)

Were diagnostics performed?*

What diagnostics were requested?*

Did you transport to the lab or collection centre?*

Did you write a Script?

If yes, what scripts did you write - please be specific so that we have enough info if the pharmacy calls or for repeat scripts (medication, dose, repeats etc)

What category is this patient?

What follow-up is needed by our care team for this family?

What date is this follow up needed?

Please provide more information for our care team so we can properly follow up and support this client (Type of follow up/frequency/level of care)

Payment

O Paid Cash?

Please tick this box if the Owner paid in CASH

If so, how much?*

Vet Feedback Form old