Customer Satisfaction Survey

We are always doing our best to improve and we carefully review all of the input we receive.

Please let us know how your last visit went.

Communication prior to appointment

Great

Good

Fair

Poort

N/A

Waiting room time

Great

Good

Fair

Poor

N/A

Appointment availability

Great

Good

Fair

Poor

N/A

Fees

Great

Good

Fair

Poor

N/A

Quality of care from staff

Great

Good

Fair

Poor

N/A

Quality of care from doctor

Great

Good

Fair

Poor

N/A

Concerns or questions answered

Great

Good

Fair

Poor

N/A

Overall quality of care

Great

Good

Fair

Poor

N/A

Schedule

Preferred time for appointments

Preferred day for appointments

Do you plan on returning for your next comprehensive examination?

Yes

No

Products

Satisfaction with eyeglasses

Great

Good

Fair

Poor

N/A

Satisfaction with contact lenses

Great

Good

Fair

Poor

N/A

Range of eyeglasses selection

Identification - This section is optional.

Why did you choose us for your eye health care?

First Name

Last Name

Comments