Satisfaction Survey Home Contact Us Satisfaction Survey Satisfaction SurveyPlease let us know how your last visit went. Please enable JavaScript in your browser to complete this form.Service RatingsCommunication Prior To AppointmentGreatGoodFairPoorN/AAppointment AvailabilityGreatGoodFairPoorN/AWaiting room timeGreatGoodFairPoorN/AFeesGreatGoodFairPoorN/AQuality Of Care From StaffGreatGoodFairPoorN/AQuality Of Care From DoctorGreatGoodFairPoorN/AConcerns Or Questions AnsweredGreatGoodFairPoorN/AOverall Quality Of CareGreatGoodFairPoorN/ASchedulingPreferred Day For AppointmentsSelect Appointment DaySundayMondayTuesdayWednesdayThursdayFridaySaturdayNo preferencePreferred Time For AppointmentsSelect Appointment Time7 AM to 9 AM9 AM to 5 PM5 PM to 8 PM8 PM to 10 PMDo you plan on returning for your next comprehensive examination?YesNoWould you schedule appointments online?YesNoProductsSatisfaction With EyeglassesGreatGoodFairPoorN/ASatisfaction With Contact LensesGreatGoodFairPoorN/ARange Of Eyeglasses SelectionGoodToo FewToo ManyToo Many Of The Same TypeIdentification - This section is optional.Why did you choose us for your eye health care?Your Name (Optional)FirstLastAdditional CommentsWebsiteSubmit Search Schedule An Appointment Patient History Form Customer Satisfaction Survey Contact Form Patient Portal Call Us (779) 210-8133 Fax Us (815) 329-6128 Follow Us On Facebook