Satisfaction Survey

How were your phone calls handled?

Excellent Good Fair Poor N/A

How was availability of appointments?

Excellent Good Fair Poor N/A

How was the waiting room time?

Excellent Good Fair Poor N/A

How was the care you received from our technical staff?

Excellent Good Fair Poor N/A

How was the quality of care you received from the Doctor?

Excellent Good Fair Poor N/A

How did the Doctor answer any concerns or questions you had?

Excellent Good Fair Poor N/A

How was the waiting time for your eyeglasses?

Excellent Good Fair Poor N/A

If you were fit with contact lenses, how would you rate the fitting follow up care and overall satisfaction with the lenses?

Excellent Good Fair Poor N/A

How would you rate the overall quality of the care you received?

Excellent Good Fair Poor N/A

The selection of eyeglasses was (Check one)

Just right Too many of the same type Too many to choose from/too confusing Not enought to choose from

Our fees were (Check One)

Much lower than expected Slightly lower than expected Slightly higher than expected Much higher than expected

What is the best day of the week for you to come to our office? (Check one)

Monday Tuesday Wednesday Thursday Friday Saturday No Preference

What is the best time of day for you to come to our office (Check one)

7 - 8 A.M. 8 A.M. - 5 P.M. 5 - 7 P.M. 7 - 8 P.M. No Preference

Would you use the internet/email/web page to book appointment or order contact lenses?

Yes No Not on the internet

Why did you ORIGINALLY choose our office for your eye health cares?

Will you return next year for your yearly comprehensive eye health examinations?

Yes No

If no, why not?

Optional: Name

Optional: Name of assistant(s) who helped you

Additional Comments:

If you gave us your name above, may we call you to further discuss your comments?

Yes No

Email

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