Customer Satisfaction Survey

Communication prior to appointment: Great Good Fair Poor N/A
Appointment availability: Great Good Fair Poor N/A
Waiting room time: 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
Preferred day for appointments:
Preferred time for appointments:
Do you plan on returning for your next eye exam: Yes No
If no, please tell us why?:
Satisfaction with eyeglasses: Great Good Fair Poor N/A
Satisfaction with contact lenses: Great Good Fair Poor N/A
Range of eyeglass selection to choose from: Great Good Fair Poor N/A
Why did you choose us for your eye care?
Any additional comments you'd like us to know:
Your name (optional):


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