Patient Survey

Of the questions that apply to you, please grade our performance during your recent visit to our office. Your responses are totally confidential and are very important to help us make changes that improve your experience with us.

Please grade your experience with us, A-E, with “A” being the best and “E” being the worst.

Office Location
  1. Were you greeted in a friendly and helpful manner?
  2. Did you receive the help that you needed with billing and insurance?
  3. Was your waiting time to see the Doctor satisfactory?
  1. Was your Eye Exam thorough and findings fully explained?
  2. Did the Doctor listen and show concern for you?
  3. Were your vision problems solved?
  1. Was your waiting time to see the optician after exam with the Doctor satisfactory?
  2. Was the Optician knowledgeable, helpful and friendly?
  3. Were your glasses delivered in a reasonable amount of time?
  4. Are you pleased with the way your new glasses look and feel?
  5. Size, diversity and quality of frame selection?
Contacts: (if applicable)
  1. Were your contacts delivered when promised?
  2. Were you well instructed in contact lens care and handling?
  3. Are you pleased with your vision using contacts?
  4. Was your contact lens fitting scheduled in a timely manner?
  1. How would you rate the quality of products and services?
  2. Were the fees fair, reflecting good value?
  3. How would you rate the staff's desire to solve problems and make visit enjoyable?
  4. Was the office clean, comfortable and attractive?
  5. How likely are you to refer others to our office?
  6. Your overall grade of your experience with our office?
Additional Comments:
Optional Information:
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