Understanding clients' wants and needs is vital to the sustained success of any service business, and veterinary medicine offers no exception. The Veterinary Teaching Hospital (VTH) at the Michigan State University College of Veterinary Medicine (MSU-CVM) has successfully maintained a position at the forefront of the veterinary profession throughout most of its history. The staff has consistently been composed of clinicians who have been chosen because of their excellence and expertise. However, the assumption that emphasis on clinical excellence will, by itself, provide the foundation for sustained success in the client flow and business at the hospital has been unchallenged to date. Additionally, there are many areas in veterinary medicine that are becoming increasingly popular (e.g. oncology). Addition of, or attention to, these services is crucial in retaining our leadership role within the veterinary community. The results of a previous study indicated that 75.4% of equine clients chose MSU-VTH because they were referred by their primary veterinarian. One of the objectives of this study was to determine which factors influenced referring veterinarians in determining whether they refer their patients to MSU-VTH. Additionally, this study was designed to identify areas for possible expansion/contraction of our current service offerings in order to better serve the needs of our clients and referring veterinarians. The results of this study can be used as an outline for the development of a plan to maintain and improve referring veterinarian satisfaction and, ultimately, to sustain the teaching caseload and business of the hospital. In addition, this endeavor will serve to set a good example for our students by modeling the best management practices and establishing a critical blend of quality medicine/surgery and customer service.