Caroline Zeglen and I at Pendergrass Library https://www.lib.utk.edu/agvet/ created this form in July 2017 to try it at a continuing education seminar day to collect responses from veterinarians in practice and their teams tying into the 2017-18 theme of "Open in Order to..."
I got two responses at the meeting, one solicited and one unsolicited. Copies of the form were available on clipboards in the library booth.
I will continue to use it 2017-18. The plan is to incorporate the comments veterinarians shared with us into our new version of the UTK digital archive http://trace.tennessee.edu/.